A Simple Method of Controlling Dorsal Vein Complex Using Harmonic Scalpel During Laparoscopic Radical Prostatectomy

Abstract

Introduction and Objective:

To describe a novel technique to control dorsal vein complex (DVC) during laparoscopic radical prostatectomy.

Methods:

We have been using a harmonic scalpel to control DVC before apical dissection and urethral division. Five patients underwent laparoscopic radical prostatectomy using this novel technique. DVC has been exposed, and then superficial complex and deep complex were selectively transected using harmonic scalpel under direct vision. Patients' mean age was 72 (range, 66–78) and clinical stage was T2 or T3 without lymph node metastasis. Median prostate specific antigen value was 7.9 ng/ml (interquartile range, 4.4–10.2). Nerve sparing method was not applied because of high clinical stage and history of erectile dysfunction.

Results:

We could finish the whole procedure without open conversion. No additional securing technique was needed to control bleeding. The mean operative time was 390 min (325–475), mean blood loss was 250 mL (130–400), and transfusion was performed in one patient postoperatively. Mean catheterization duration was 11 days (8–14). Three patients of them had a remnant positive margin at apex. Three patients had continence after 3 months from surgery and three patients are using 1–2 pads per day at 1-month postoperative follow-up.

Conclusions:

A selective DVC controlling technique using harmonic scalpel is feasible and it makes the procedure easier.

Acknowledgment:

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST)(No.2011-0020128).

No competing financial interests exist.

Runtime of video: 7 mins 39 secs