Open Prostatectomy

Definition
  • Excision and removal of the prostate gland via a surgical incision.
  • Although 90 percent of prostectomies are performed via the transurethral approach, there are occasions when a surgical incision and removal is required.
  • Four approaches can be used to excise the prostate gland:
    1. Transurethral prostectomy – removal of the prostatic tissue and/ or lesions transcystoscopically.
    2. Suprapubic prostectomy – performed after incising the bladder, which permits correction of associated conditions, such as calculi or diverticula.
    3. Retropubic prostectomy – avoids entry into the bladder and allows for good visualization of the field. Limited malignancies may be treated by this approach.
    4. Perineal prostectomy – affords excellent visualization and access to the prostate and seminal vesicle.
  • A bilateral vasectomy may be performed in conjunction with a prostectomy to avoid retrograde infections.

open-prostatectomy

Positioning
  • Suprapubic and retropubic: Supine with slight trendelenberg
  • Perineal: Exaggerated lithotomy with slight trendelenberg.
Packs/ Drapes
  • Suprapubic: Laparotomy pack, extra drape sheets, transverse lap sheet.
  • Retropubic: Laparotomy pack, impervious sheet, folded towel over scrotum and penis.
  • Perineal: Cysto pack, towels around the perineal area, fenestrated sheet.
Instrumentation
  • Majoy tray
  • Long instruments
  • Heaney needle holder
  • Lahey clamps
  • Prostatic urethral sounds
  • Hemoclips
Supplies/ Equipment
  • Basin set
  • Blades
  • Needle counter
  • Dissector sponges
  • Irrigation syringe
  • Suction
  • Solutions
  • Lubricants
  • Sutures
  • Suprapubic catheter
  • Drain
  • Foley catheter
Procedure
  1. The surgeon makes the appropriate incision, and after access is gained into the space of Retzius, a self- retraining retractor is placed into the wound.
  2. Before the bladder is opened, the surgeon places two traction sutures on either side of the incision.
  3. The bladder may be grasped with a Allis clamp and pulled upward.
  4. A short incision is made into the bladder, and suction is applied to drain its contents.
  5. After draining the bladder, the surgeon places a bladder retractor in the bladder wound.
  6. The surgeon incises the prostatic mucosa by either knife or cautery, and the bladder retractors are removed.
  7. Using finger dissection, the surgeon enucleates the diseased prostate from its fossa, and the specimen is delivered and passed off to the scrub person.
  8. The cavity is inspected for bleeders. Many surgeons prefer to pack the cavity with a sponge for a few minutes to maintain hemostasis.
  9. Large bleeding vessels are ligated with suture or ligiclips.
  10. Oozing surfaces may be covered with a hemostatic agent.
  11. A foley catheter is placed into the bladder neck. Some surgeons prefer to drain the bladder through a suprapubic catheter, which is placed in the wound at this time through a small incision near the suprapubic incision.
  12. The bladder is then closed with two layers of 0 or 2-0 chromic interrupted sutures.
  13. A large penrose drain is placed into the space of Retzius; and the wound is closed in a routine manner.
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