In this video, you will learn firsthand from Dr. Dipen J. Parekh, the founding director of the Desai Sethi Urology Institute and director of robotic surgery, who has performed over 5,000 robotic urologic procedures. Narrated by Dr. Archan Khandekar, clinical instructor at the Desai Sethi Urology Institute, this video showcases the precision and expertise behind a robotic-assisted laparoscopic prostatectomy (RALP). Watch as state-of-the-art robotic technology is used to meticulously remove the prostate, ensuring optimal functional and oncological outcomes for patients. This groundbreaking procedure reflects the present and future of urologic care.
We will be showing a robotic radical prostate be coming in a 70 year old patient with prostate cancer. It was recent and three plus four, mainly on the right side of the prostate. We start off here with the posterior dissection. What we are doing here is creating a plane posterior to the prostate, giving us access to the seminal vesicles and the vast refer everything on the right side, right, a plane created separating the prostate from the rectum can be seen here. Subsequently, you can see the vast difference on the right side getting cut. This is followed by the separation of the seminal vesicle on the right side and then subsequently on the left. The advantage of the robotic approach is that it allows us to go posterior to the prostate, which would be significant if you did it open. John. Also as the camera in the robotic approach goes very close to the organs. You can see the great magnification and visualization of each and every step that we are performing at the moment. OK. The muscles do more t don't do more. But yeah, that's true. That's very true. And they are more on Twitter. No, I'm just hitting something. This babe completes the resection of the plastic posteriorly from the rectum section day. Followed by this, we switch our focus to dropping the bladder. The bladder is dropped by retracting the medial umbilical ligament first and creating the pain between the bladder and the abdominal wall. Hm. See how stuck as bad. It is a appendectomy or whatever or also mentioned, like as the bladder gets completely dropped from an abdominal wall, you get access to the prostate from above, which is conventionally called as the indeed approach ar have you? Sorry, I do. So, what I wanted to see was the bones and all these difficult things, you need to always look for your main landmarks. In this case, it is a pubic bone and then once you see that anything just stay close to the bone and all these things need to go. Currently, you can see the prostate which is just adjacent to the bone and it's covered by the prep prosthetic fat, which is hence support dissected. Ok. After getting access to this, can we proceed by dissecting a plane between the prostate? The foley catheter that is inserted into the bladder is visualized and pulled out. Yeah, she pushed. Mhm I got it. The next step involves completely separating the prostate from the bladder. What you can see there is the bladder neck, keeping a small bladder neck is extremely crucial. A small bladder neck eventually helps in reach incontinence much faster for the patient sounds great. You can see that the seminal vesicles and the vast difference that were previously detective from the posterior approach are retaining a robotic vessel sealing device is subsequently used to cut the blood supply. It is the prosthetic pedicle. Yeah. Yeah. The steps done here are crucial where cold cuts are applied with the season to separate the nose from the prostate by Turkson keeping eventual exiled function for the patient. Once you can see that these nerves are gradually eased off the prostate, the rest of the blood supply is devo from the prostate. You can see this being done by the vessel header yet as it was done previously on the left side, do you know different devices have been used to cut the blood supply to the prostate? These range for applying clips hemoclips which are basically absorbable clips. Also using the bipolar quatre device and the vessel cedar device. As we are showing in this particular video, these are the parts of the surgery where meticulous dissection is extremely crucial because these are the nerves that are left behind that help with the eventual erectile function for the patient. It's also very important to stay away from the prostate. So as to not leave any actual prosthetic tissue behind that can cause the cancer to come back. Ok. The next step involves us going back to the interior of the prostate where the dorsal venus complex that overlies. The urethra is cut during this step, the abdominal pressure is raised. This decreases the bleeding from the dorsal venous complex as much as possible, which in the the prostate that is then completely separated from all its sides is bagged. Awesome. The next step involves the removal of the lymph nodes on both sides. As you can see, this is the removal of the lymph nodes on the right side. The lymph nodes are freed from its attachments by cry as well as cliffs. The clips are applied to minimize the post operative incidences of lymphocyte as much as possible. The presentation. Yeah. So I just wanna go through with you 85. So you have a No, you're right. The dorsal venus complex that was cut before as we showed is then switched off. This is done by a barb suitor. A weel of 30. You see it. No, no, we draw the foia a little bit. The next and final step of the procedure is the anastomosis whereby the cut end of the bladder, which is the bladder neck is joined with the urethra. This is done by a wheel of 30 suture. There are two wheel of 30 sutures, one dyed and one undyed. As you can see, they are used for each side of the anastomosis. OK. It is extremely essential to have good co ordination between the assistant and the surgeon during this step on the right side. Yeah, that as the anastomosis proceeds, the bladder and the urethra are gradually pulled together, mainly the bladder is pulled towards the urethra. You know, you know about your hand out chair ceremony, right? You know about your end out chair ceremony. Yeah. Yeah. Yeah. It's a big deal. It's in, in the campus. So we should, we should have, we should announce Sandra should let Sandra know that the people from the department can attend. Yeah. No, thanks. The barb nature of the sutures, make sure that once the suture is passed through either the urethra or the bladder neck, it does not slide back. Once the final suture is passed through the ladder, all the futures are tied together. Eventually the bladder is filled and we take for any leaks that may be present in the anastomosis. As you can see in this current step, an absolute watertight anastomosis. Ok. Good. Remove eventually we decrease the pressure of the abdomen to check for any bleeding and subsequently all the instruments are removed to conclude the procedure.
