Dissection of Vasa Deferentia and Seminal Vesicles

A plane is identified between the layers of Denonvillier's fascia, and the dissection is continued inferiorly in the midline. Often the vasa is easily visualized in the midline, but may be widely separated, especially with a significantly enlarged prostate (Fig. 5). The second assistant removes the catheter and grasps the posterior prostate and the edge of Denonvillier's fascia for traction facilitating dissection of the vasa. Each vas is dissected free from surrounding tissue then divided. The second assistant grasps the prostatic end and the first-assistant grasps the proximal end. Adequate exposure allows the ipsilateral seminal vesicle to be dissected free from the surrounding tissue. After the vasa and seminal vesicles are isolated, the second assistant grasps both vasa and seminal vesicles and provides anterior and superior traction on the prostate. The dissection is then continued posteriorly in the midline between the layers of Denonvilliers' fascia as far distal as possible, usually to the level of the prostatic apex (Fig. 6). This step greatly facilitates the subsequent dissection of the neurovascular bundles and the apex.

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