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Laparoscopic Prostatectomy Intra- and Extraperitoneal Techniques George Ferzli, MD, FACS Robert Cacchione, MD; Paul Sayad, MD Department of Laparoscopic Surgery Staten Island University Hospital
Prostate Cancer Statistics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methods of Treating Localized Prostate Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evolution of Laparoscopic Surgery for Prostate Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy of the Prostate ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prostatectomy: Analogy to Fundoplication esophageal tumor - prostate   stomach - bladder   esophagus - urethra   vagus – neurovasc. bundle
Placement of Trocars ,[object Object],[object Object]
Placement of Trocars (Totally Extraperitoneal Technique)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Steps of the Procedure
Step 1: Transperitoneal  Access to Seminal Vesicles ,[object Object],[object Object]
Step 1: Transperitoneal  Access to Seminal Vesicles ,[object Object],[object Object]
Step 2: Dissection of the Prostatorectal Space ,[object Object],[object Object],[object Object]
Step 2: Lateral Dissection of Rectum vas deferens   neurovascular bundle   seminal vesicle   urethra   pubic bone   ureter   bladder   rectum   prostate   dorsal vein
Step 3: Dissection of the Anterior Pubic Space ,[object Object],[object Object],[object Object],[object Object]
Step 3: Dissection of the Anterior Pubic Space
Step 3: Division of Dorsal Vein
Step 3: Section of Urethra at Prostatic Apex
Step 4: Mobilization of the Prostate ,[object Object],[object Object],[object Object]
Step 4: Sectioning of Anterior Bladder Neck
Step 4: Ureterovesicle Anastomosis
Laparoscopic Prostatectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results of Laparoscopic Prostatectomy Schuessler.  Urol.  50:854-57, 1997.
Results of Laparoscopic Prostatectomy Raboy, Albert, Ferzli.  Surg Endosc.  12:1264-67, 1998.
The Last French Revolution ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Next French Revolution ,[object Object],[object Object],[object Object],[object Object],[object Object]
Results of Laparoscopic Prostatectomy Guillonneau.  J Urol  163:418-22, 2000.
Results of Laparoscopic Prostatectomy Abbou.  Urol.  55:630-633, 2000.
Robotics in Urology ,[object Object]
Totally Extraperitoneal vs Transabdominal ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object],[object Object]

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