The preperitoneal space is further expanded under direct visualization. After identification of the left anterior-superior iliac spine, a 5 mm port is placed 2 cm medial to this bony landmark. A 5 mm trocar is placed on the left pararectal line, 1-2 cm caudal to an imaginary line extending from the umbilicus to the left anterior-superior iliac spine. In a similar manner, two additional ports are inserted in the contra lateral side of the abdomen. Overall, the port placement duplicates laparoscopic entry during extraperi-toneal laparoscopic radical prostatectomy (Fig. 1) (23).
TABLE 4 ■ Preoperative Preparation
Bowel preparation is not routinely performed; but a clear liquid diet is advised for the day prior to the surgery and a bisacodyl suppository the night before surgery Aspirin and other nonsteroidal analgesic or anticoagulants are discontinued one week before surgery Low dose subcutaneus heparin low molecular weight in patients at high risk for deep vein thrombosis Intravenous quinolones (Ciprofloxacin) is administered for antibiotic prophylaxis
TABLE 5 ■ Technical Steps for Laparoscopic Simple Prostatectomy
Patient positioning Creation of the preperitoneal space Placement of the tracers Transverse cystotomy Retraction of the medial lobe Development of subcapsular plane Prostatic adenomectomy Trigonization of the prostatic fossa Suture repair of the cystotomy
The space of Retzius is entered and the anterior surface of the prostate capsule is cleared of the overlying fatty tissue. The superficial dorsal vein on the anterior aspect of the prostate is carefully coagulated with the harmonic scalpel.
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