Dorsal Venous Complex: Cold-Cut Technique

Abstract

Introduction:

In this video, we demonstrate control of the dorsal venous complex (DVC) using a cold-cut technique. At this point, the entire dissection has been completed except for the apical dissection.

Materials and Methods:

The Foley catheter is placed across the urethra and visually confirmed to exit out the prostate base. This is crucial, since its presence makes it impossible to pinch the urethra with the left hand Maryland bipolar. This provides key visual feedback to differentiate between the dorsal vein and urethra. A 4-0 vicryl on an RB-1 needle is preplaced into the abdomen to minimize the time delay for stitch placement, while the vein is open. Pneumoperitoneum is increased to 20 mm Hg.

Results:

The fourth arm pulls back on the prostate at its base, and while the left hand pinches the vein closed, the scissors cut along the bipolar. As an analogy, think of a barber giving a haircut over his/her fingers. As the vein is released, the fourth arm is adjusted to keep rolling the prostate out of the pelvis. This not only allows the surgeon to follow the contour of apical prostate, pinching and cutting keeps the plane of dissection a few millimeters off of the prostate, potentially decreasing apical margin positivity. Cavernosal arteries are sometimes encountered within the DVC, and can be monopolar electrocoagulated. After the urethra is defined, a running 4-0 vicryl suture is placed, and the throws need not pass deeply into the pelvic floor. Simply catching the edges of open vein to oppose them is all that is required. The pneumoperitoneum is then returned to 15.

Conclusion:

Even with an elevated pneumoperitoneum, the DVC bleeds variably from patient to patient, at times minimally if at all, and other times substantially, in which all steps must proceed expeditiously.

Source: David Canes, MD, Lahey Clinic.

No conflicts of interest. There are no commercial associations in connection with this video.

Runtime of video: 5 mins 52 secs