, Peter Wiklund2 and Jorn H. Witt3
(1)
Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
(2)
Department of Urology, Karolinska University Hospital, Stockholm, Sweden
(3)
Department of Urology and Paediatric Urology, St. Antonius-Hospital-Prostate Center Northwest, Gronau, Germany
Abstract
with contributions from Thomas E. Ahlering, Randy Fagin, Rolf Gillitzer, Mani Menon, Alexander Mottrie, Vipul R. Patel, Bernardo Rocco, Charles-Henry Rochat, Alok Shrivastava, Stefan Siemer, Michael Stöckle, Gerald Tan, Ashutosh K. Tewari, Joachim W. Thüroff, Christian Wagner, and Vahudin Zugor
4.1 Port Placement
Extraperitoneal
Fig. 4.1
Balloon dilatation of the extraperitoneal space
Fig. 4.2
First robotic trocar placement. The tip of the right index finger guides the blunt obturator tip of the 8 mm trocar down into the extraperitoneal space, which has been created by prior balloon dilatation
Fig. 4.3
Expanding the extraperitoneal space
Transperitoneal
Fig. 4.4
Supraumbilical access and positioning of the ports
Fig. 4.5
Video-guided port placement under direct vision
4.2 Cavum Retzii
Normal
Fig. 4.6
Initial view of the space of Douglas. The entrance to the cavum retzii is still closed
Fig. 4.7
The bladder is extraperitonealised
Special
Fig. 4.8
Transperitoneal view after laparoscopic mesh implantation
Fig. 4.9
Adhesiolysis of fibrotic adhesions between the implanted mesh and small intestine
4.3 Lymphadenectomy
Limited Lymphadenectomy
Fig. 4.10
Lymph nodes between the iliac vein and the fossa obturatoria
Fig. 4.11
Fossa obturatoria following limited lymph node dissection
Extended Lymphadenectomy
Fig. 4.12
Proximal view onto the iliac bifurcation and medialised ureter
Fig. 4.13
Distal view with separated iliac vein and artery
4.4 Endopelvic Fascia
Incision
Fig. 4.14
Incision of the endopelvic fascia
Accessory Pudendal Vessels
Fig. 4.15
Preparetion of accessory pudendal vessels
4.5 Dorsal Vascular Complex
Exposition and Incision
Fig. 4.16
The trigone between both endopelvic fascias and the dorsal venous complex is de-fatted for further dissection
Fig. 4.17
Incision of the endopelvic fascia and exposure of the dorsal vascular complex
Ligature and Stapler
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