Minimally Invasive Radical Prostatectomy

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Presentation transcript:

Minimally Invasive Radical Prostatectomy Mitchell R. Humphreys, MD, Matthew T. Gettman, MD, George K. Chow, MD, Horst Zincke, MD, PHD, Michael L. Blute, MD Mayo Clinic Proceedings Volume 79, Issue 9, Pages 1169-1180 (September 2004) DOI: 10.4065/79.9.1169 Copyright © 2004 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Abdominal landmarks for laparoscopic trocar placement. Mayo Clinic Proceedings 2004 79, 1169-1180DOI: (10.4065/79.9.1169) Copyright © 2004 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Left, Trocar placement for inverted “fan” transperitoneal approach. 1 = 10- or 12-mm trocar at the inferior umbilical crease; 2 = 5-mm trocar in lateral rectus border, 2 finger breadths below umbilicus; 3 = 12-mm trocar in lateral rectus border, 2 finger breadths below umbilicus; 4 = 5- or 10-mm trocar, 2 finger breadths medial to anterior superior iliac spine; 5 = 5-mm trocar, 2 finger breadths medial to anterior superior iliac spine. Right, Trocar placement for “W” configuration transperitoneal approach. 1 = 12-mm trocar at the inferior umbilical crease; 2 = 10- or 12-mm trocar in left lateral rectus sheath, 2 to 4 cm below umbilicus; 3 = 5-mm trocar in left lateral abdomen at or just above level of umbilicus; 4 = 10- or 12-mm trocar in right lateral rectus sheath, 2 to 4 cm below umbilicus; 5 = 5-mm trocar in right lateral abdomen at or just above level of umbilicus. Mayo Clinic Proceedings 2004 79, 1169-1180DOI: (10.4065/79.9.1169) Copyright © 2004 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Trocar placement for extraperitoneal approach. 1 = 10- or 12-mm Hasson trocar at the inferior umbilical crease; 2 = 5-mm trocar at the midline, 3 to 5 cm below umbilicus; 3 = 5-mm trocar in right lateral rectus border, 2 cm below umbilicus; 4 = 5-mm trocar, 2 finger breadths medial to right anterior superior iliac spine; 5 = 10- or 12-mm trocar, 2 finger breadths medial to left anterior superior iliac spine. Mayo Clinic Proceedings 2004 79, 1169-1180DOI: (10.4065/79.9.1169) Copyright © 2004 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Trocar placement for extraperitoneal robotic approach. 1 = 12-mm trocar, 1 finger breadth inferior to the umbilicus (for the camera); 2 = 5-mm trocar, 2 finger breadths above pubic symphysis in the midline; 3 = laparoscopic robotic port, 8-mm trocar along the left lateral rectus border, 1 hand breadth inferior to trocar No. 1; 4 = laparoscopic robotic port, 8-mm trocar along the right lateral rectus border, 1 hand breadth inferior to trocar No. 1; 5 = 5-mm trocar along the right lateral rectus border, 1 to 2 cm inferior to trocar No. 1; 6 = 12-mm trocar, 2 finger breadths medial to the anterior superior iliac spine. The transperitoneal technique differs in that trocars No. 3 and No. 4 are 4 cm cranial to their position depicted here. Mayo Clinic Proceedings 2004 79, 1169-1180DOI: (10.4065/79.9.1169) Copyright © 2004 Mayo Foundation for Medical Education and Research Terms and Conditions