结扎速血管闭合系统

anastomosis Two running sutures
technique
Tips and tricks in Neobladder- urethra anastomosis
A traction stitch to relieve the tension
Changing to head-up position
➢ Nerve sparing ➢ Non nerve sparing
How to protect the neurovalscular bundle
Nerve sparing techniques
Non nerve sparing techniques
Step 5: Dividing the urethra
Step 4:Dividing the lateral pedicles of the bladder and the prostate
Step 5: Dividing the apex of the prostate and urethra
Step 6: Extracorporeal construction of Ileal neobladder
Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder
——Key Steps to Success
Huang Jian
The 2nd Affiliated Hospital Sun Yat-Sen University, Guangzhou China
Step 2: Dissection of seminal vesicle
opening Denonvelia’s fascia
Step 3: Exposing the anterior aspect of bladder and prostate
Step 4: Dividing the lateral pedicles of the bladder and the prostate
Discuss the techniques of key steps in LRCOIN
Haemostatic Instruments
Harmonic scalpel PK system Bipolar forceps LigaSure vessel sealing system Electric hook Hem-O-Lok
separating rectum from prostate Dividing lateral peadicle close to the
prostate Transecting the urethra while pulling
up the prostate apex
Different methods in dividing the lateral paedicles
Studer pouch T pouch Hemi-kock pouch
ileal chimney
extramural serouslined tunnels
ileal nipple
Mucosal sulcus
Ureteral nipple
Step 7: Neobladder- urethra
transecting uretha
Step 6: Removal the spacimen
and neobladder construction
The technique of Extracorporeal formation of neobladder
5 cm of midline subumbilical skin incision
Hem-o-lokቤተ መጻሕፍቲ ባይዱ
PK System
LigaSureTM Vessel Sealing System
图1-2-10 结扎速血管闭合系统
Ultracision-Harmonic Scalpel
Patien’s position and trocar site
The Major Steps of the Procedure
Introduction
Laparoscopic radical cystectomy with orthotopic neobladder (LRC-OIN) is increasingly accepted by urologists.
It is no more the issue of feasibility but the issue of improvement for this procedure.
Step 2 to step 5: Cystectomy
Posterior aspect Anterior aspect Bilateral pedicles Prostate apex and urethra
How to avoid rectum injury
Correctly localized seminal vesicle Opening the Denonvelia’s fascia and
extent: standard or extented Using instrument: harmonic scalpel, PK system
bipolar clamp and electric scissors, or electric hook and LigaSure Attention: blood vessel and obturator nerve injury lymphatic leakage tumor cell seeding
Intracorporeally or extracorporeally Reconstruction: Studer pouch, hemi-kock
pouch, T pouch, M pouch,
Implantation of ureters: ileal chimney, ileal nipple, extramural serous-lined tunnels, mucosal sulcus, ureteral nipple,
M shape ileal pouch Implantation of ureters directly to the
posterior wall of the pouch by means of ureteral half nipple.
Different techniques in formation of neobladder
Two running suture technique better than interrupted, or running suture technique.
Attention: the catheter out side the neobladder
Summary
The Surgical procedures of LRC-OIN can be improved by reasonable sequence, standard maneuver and correct use of instruments.
➢ LigaSure ➢ PK Forceps ➢ Endo-GIA ➢ Harmonic scalpel
How to avoid the tumor seeding
➢ Avoidingbladder wall perforation ➢ Don’t transgressing the tumor boundaries, ➢ Blocking up the bladder neck before
Step 1: Pelvic Lymphadenectomy with
electric hook and LigaSure
Techniques of Pelvic Lymphadenectomy
Sequence: Lymphadenectomy before or after cystectomy
Step 1: Pelvic lymphadenectomy
Step 2:Dissection of seminal vesicle and Denonvelia’s fascia to expose the posterior aspect of prostate
Step 3: Exposing the anterior aspect of bladder and prostate