
PROSTATECTOMÍA LAPAROSCÓPICA DIGITALMENTE ASISTIDA
Eduardo Sánchez Badajoz, Adolfo Jiménez Garrido
PROSTATECTOMÍA LAPAROSCÓPICA DIGITALMENTE ASISTIDA
OBJECTIVES: Laparoscopic prostatectomyis the treatment of choice for localized prostate cancer.The learning curve for unexperienced teams is dauntinglysteep because it is associated with high incidence ofcomplications and such long operation times that theprocedure becomes almost unacceptable. Therefore,we needed to seek an alternative for this operation thathas been almost unmodified since first description in1998.METHODS: The patient is placed in lithotomy positionand draped with an urological apron similar to the oneused for transurethral resection. A beniqué sound isintroduced up to the bladder and a 12 mm incision ismade in the perineum, through which we slowly introducethe index finger touching the posterior aspect of theprostate. We advance the finger further longitudinallyand laterally separating the rectum all the way to thebladder neck and prostatic pedicles on each side.Having freed the prostate, generally the most hazardousmanoeuvre, we can then carry out a conventionallaparoscopic prostatectomy, safely and quickly becausethe most difficult step, rectum dissection, has beencarried out.RESULTS: Digital separation of the prostate through aperineal incision facilitates the operation a lot and shortensoperation times significantly, allowing us to avoid theuse of one or two trocars. At this time, we can not presentstatistical analysis because our limited experience, butthere are significant advantages making the procedureeasier and operation time shorter. Furthermore, thetechnique may also be used for laparoscopic cystectomy.CONCLUSIONS: laparoscopic prostatectomy isconsidered a very difficult procedure, with an unacceptablehigh incidence of complications, being rectum perforationthe most feared. Therefore, laparoscopic prostatectomyassisted by digital manipulation through a small perinealincision appears to be a most welcome developmentwith benefits similar to those brought ten years ago byintroduction of hand assisted laparoscopy.
Prostatectomy / Laparoscopy / Finger assisted / Perineum / Prostate cancer {{custom_keyword}} /
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