Externalized urachal suture: novel approach to bowel and bladder retraction during transperitoneal laparoscopic radical prostatectomy

Urology
Niels-Erik B JacobsenMichael G Hobart

Abstract

Although laparoscopic radical prostatectomy (LRP) has emerged as a legitimate minimally invasive surgical alternative to open radical retropubic prostatectomy, the technical difficulty of this advanced laparoscopic procedure remains an obstacle to its widespread use. We report a novel surgical technique for the purpose of bowel and bladder retraction during transperitoneal LRP that improves visualization and negates the need for additional working ports or steep Trendelenburg positioning. A 35-cm absorbable suture is secured intracorporeally to the urachus. The distal end of the suture is then pulled out through the left subcostal abdominal wall in the midaxillary line using a Carter-Thomason CloseSure device. Application of tension on the suture retracts the bladder superiorly and prevents bowel from entering the surgical field. This maneuver provides excellent exposure of the bladder neck and prostate and minimizes the need for additional fan retraction or steep Trendelenburg positioning. In 20 consecutive procedures, this step added an average of 2.2 minutes to the operative time, which averaged 169 minutes overall. Incorporation of an adjustable externalized urachal suture allows for excellent retraction of both bowel and b...Continue Reading

Related Concepts

Related Feeds

Bladder Carcinoma In Situ

Bladder Carcinoma In Situ is a superficial bladder cancer that occurs on the surface layer of the bladder. Discover the latest research on this precancerous condition in this feed.