DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Adenocarcinoma of the prostate.
POSTOPERATIVE DIAGNOSIS: Adenocarcinoma of the prostate.
OPERATION PERFORMED: Laparoscopic radical prostatectomy, bilateral nerve sparing.
SURGEON: Jane Doe, MD
ASSISTANT: John Doe, MD
ANESTHESIA: General endotracheal, local.
ESTIMATED BLOOD LOSS: 300 mL.
IV FLUIDS: 2000 mL.
COMPLICATIONS: None
SPECIMENS: Prostate, seminal vesicles, and vas.
DRAINS: 20-French Foley catheter.
DISPOSITION: Stable to the recovery room.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman found to have an elevated PSA of 4. Biopsy of the prostate revealed Gleason grade adenocarcinoma of the right base. The patient now presents for laparoscopic prostatectomy. The patient expressed understanding of the risks and benefits of the procedure and wishes to proceed. The patient does have mild erectile dysfunction, 7-8 on a scale of 1-10. He does not take any medications for this.
DESCRIPTION OF OPERATION: After appropriate informed consent had been obtained, the patient received appropriate antibiotics for the procedure. The patient was then brought to the operating room and placed in the supine position where general anesthesia was induced. The patient was then properly positioned in the supine position on the operating table, and good care was taken to pad all pressure points. He was then prepped and draped in the usual sterile surgical fashion for laparoscopic prostatectomy.
A 20-French latex Foley catheter was then easily inserted per urethra into the bladder. Sterile water, 10 mL, was placed in the balloon. Infraumbilical midline incision, 2 cm, was made. The incision was carried through Scarpa’s and the anterior rectus fascia. Using the retroperitoneal balloon dissector, the extraperitoneal space was then developed. Two 5 mm trocars were placed on the left side and then 5 and 10 mm trocars were placed on the right side of the patient per usual standard fashion.
Using the monopolar and bipolar electrocautery, the extraperitoneal space was then further developed. The external iliac veins and obturator nerves were identified bilaterally. There was no evidence of any lymphadenopathy. Given the low risk of lymph node invasion, we did not perform a lymph node dissection.
At this point, attention was turned toward beginning the prostatectomy. The endopelvic fascia was incised bilaterally, and the levator ani musculature was pushed off the prostate. The dorsal venous complex was taken with a grasper and then oversewn using a 2-0 Vicryl suture. The base of the prostate was then taken down using the UltraCision Harmonic scalpel. There was significant fibrosis around the bladder base and neurovascular bundles. We were still able to spare both neurovascular bundles in their entirety.
The ampullae of the vas deferens were taken using the Harmonic scalpel. The seminal vesicles were also taken in their entirety using the Harmonic scalpel. The apex of the prostate was taken down using the scissors without electrocautery. The apex was taken in its entirety. The urethra was then incised, and the rectourethralis muscle was taken down as well. The prostate was then passed off to a separate location within the extraperitoneal cavity. A packet of Surgicel was then placed in the area of the neurovascular bundle for hemostasis.
A vesicourethral anastomosis was then performed with two 2-0 Monocryl sutures in a running fashion. An interrupted 2-0 Vicryl suture was used to plicate the anterior bladder neck after the vesicourethral anastomosis was complete. A 20-French Silastic urethral catheter was then placed per urethra in the bladder. Sterile water, 15 mL, was then placed in the balloon. The catheter was irrigated with 150 mL of sterile saline. There was no evidence of a leak at the vesicourethral anastomosis. There was also no evidence of any clots within the bladder. The prostate was then removed through an EndoCatch bag from the midline incision.
The rectus fascia was closed with a running 0-Vicryl suture. All skin incisions were closed with a running 4-0 Monocryl subcuticular suture. Ten mL of 0.25% Sensorcaine was placed in the area of the incisions for local pain control. Sponge, needle, and instrument count was correct x2. The patient was awakened from anesthesia and transferred to the recovery room in stable condition. There were no complications.
