结扎速血管闭合系统课件.ppt

Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder  ——Key Steps to Success  Huang Jian The 2nd Affiliated Hospital Sun Yat-Sen University, Guangzhou China Introduction Laparoscopic radical cystectomy with orthotopic neobladder (LRC-OIN) is increasingly accepted by urologists. It is no more the issue of feasibility but the issue of improvement for this procedure. Discuss the techniques of key steps in LRC-OIN Haemostatic Instruments Harmonic scalpel PK system Bipolar forceps LigaSure vessel sealing system Electric hook Hem-O-Lok PK System LigaSureTM Vessel Sealing System Ultracision-Harmonic Scalpel Patien’s position and trocar site The Major Steps of the Procedure Step 1: Pelvic lymphadenectomy Step 2:Dissection of seminal vesicle and Denonvelia’s fascia to expose the posterior aspect of prostate Step 3: Exposing the anterior aspect of bladder and prostate Step 4:Dividing the lateral pedicles of the bladder and the prostate Step 5: Dividing the apex of the prostate and urethra Step 6: Extracorporeal construction of Ileal neobladder Step 7:Intracorporeal neobladder-urethra anastomosis Step 1: Pelvic Lymphadenectomy with electric hook and LigaSure Techniques of Pelvic Lymphadenectomy Sequence: Lymphadenectomy before or after cystectomy extent: standard or extented Using instrument: harmonic scalpel, PK system bipolar clamp and electric scissors, or electric hook and LigaSure Attention: blood vessel and obturator nerve injury lymphatic leakage tumor cell seeding Step 3: Exposing the anterior aspect of bladder and prostate Step 4: Dividing the lateral pedicles of the bladder and the prostate Nerve sparing Non nerve sparing How to protect the neurovalscular bundle Nerve sparing techniques Non nerve sparing techniques Step 2 to step 5: Cystectomy Posterior aspect Anterior aspect Bilateral pedicles Prostate apex and urethra How to avoid rectum injury Correctly localized seminal vesicle Opening the De