Control of Vascular Structures

Adequate hemostasis is one of the most important prerequisites of the procedure. For this purpose, several techniques have to be mastered. Minor bleeders are controlled by use of the bipolar forceps/dissector. We prefer the use of a bipolar dissector because it offers all functions of a normal dissector (i.e., grasping and retraction of tissue). The generator power should not increase 50 W to avoid secondary thermal lesions that could lead to a rectourethral fistula.

Especially on the side of prostatic pedicle control, several different instruments are preferred in different centers of excellence as listed below (6,7,20,28,29):

■ Heilbronn technique: Bipolar endodissector combined with Hemo-O-Lok vascular clips.

■ Cleveland technique: Endo-GIA vascular staplers (white color, 3.5 mm and gray color, 2.5 mm) for nonnerve-sparing approach; Hemo-O-Lok clips for nerve-sparing approach.

■ Montsorius and Creteil techniques: Bipolar endodissector combined with Hemo-O-Lok vascular clips.

■ Berlin technique: Ultrasonic endoscissor.

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