Category: Laparoscopy: Lower Tract - Malignant
Introduction & Objective : Prostate cancer is the most prevalent malignant disease in males in Costa Rica. In our institution all prostatectomies are carried out laparoscopically. It is a complex difficult procedure, specially in the anastomosis. The "Jaimy" 5 mm laparoscopic needle driver mimics the movements of the surgeon and it facilitates otherwise difficult stitch placement in the anastomosis.
Methods : The patient is placed in a conventional dorsal decubitus position. A 10 mm space maker is used beneath the umbilicus to create the extraperitoneal plane in the Retzius space. Additional 10 mm ports and 5 mm ports are placed in the standard fashion. The dorsal venous complex is controlled with 2.0 v-lock suture in a running fashion. The prostate is dissected in a retrograde manner. The seminal vesicles and vas deferens are dissected and controlled with hemolock clips. The prostate is then removed from the patients body through the infraumbilical port. The anastomosis is then carried out with aid of the Jaimy robotic 5mm needle driver. The driver allows the surgeon to deflect in a 90 degree angle both left and right, it also has a rotation feature that facilitates stitch placement. The anastomosis is performed with 2, 3.0 v-lock sutures as it is carried out with the Da vinci system. The anastomosis starts at 6 o'clock at the bladder neck and continues in a running fashion until 11 o'clock at the urethra. The first stage of the anastomosis ends with the creation of the posterior plate. A second 3.0 v-lock suture is then placed at 5 o'clock at the bladder neck and continued in a counterclockwise running fashion until the anastomosis is complete at 12 o'clock at the urethra. After placement of a 22 fr foley catheter, the bladder is then flushed with 300 cc of saline to prevent urinary fistulas. The patient is discharged 2 days after the procedure and the catheter is removed 7-10 days postoperatively.
Results : Thirty five procedures have been carried out with the "Jaimy"needle driver in the past year. The learning curve is relatively low, however, laparoscopic experience is essential to use the needle driver in a laparoscopic radical prostatectomies. There has been a decrease in operation time of about 30 minutes per case. No fistulas or Clavien III complications have been observed after the procedures.
Conclusions : The "Jaimy" 5 mm robotic needle driver is an excellent tool that enhances the surgeons ability during laparoscopic radical prostatectomies. Its use has directly impacted decrease OR time for each case. It is an excellent option for institution or surgeons that perform laparoscopic radical prostatectomies routinely but cannot afford an expensive robotic system such as the Da Vinci robot.
Mario Gonzalez– @CHAIR, Urology department, San Jose, San Jose, Costa Rica
San Jose, San Jose, Costa Rica
Dr. Mario Gonzalez MD, Chair of Urology Department Hospital La California, San José, Costa Rica
University of Medical Sciences, Costa Ríca
Professor of Urology at University of Costa Rica
Past residency in urology program coordinator for University of Costa Rica
Fellow in Laparoscopy and minimally invasive urologic surgery in Hospital La Floresta, Caracas, Venezuela