原创力文档- 1、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。。
- 2、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击 这里二次下载。
- 3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
- 4、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
- 5、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
- 6、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
- 7、VIP文档为合作方或网友上传，每下载1次， 网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档
Intracorporeal Neobladder
Peter Wiklund
Karolinska Institute
Patient selection
Patients with significant co‐morbid conditions should be cleared after consultation with
the specialists in medicine, especially for their cardiopulmonary status. In our opinion
patients not suitable for a robotic approach are patients with decreased pulmonary
compliance that would not tolerate Trendelenburg position. Furthermore, patients with
a history of previoutensive abdominal surgery may be a relative contraindication.
Preoperative preparation
Broad spectrum intravenous antibiotics are given prior surgery and a stoma site is
marked. Contrary to some other studies we do not use a pneumatic leg compression
system due to risk of decreased vascular perfusion during the procedure. We start the
patients on low‐molecular weight heparin (4,000 units) the evening before surgery and
until the patient is fully mobilized. After induction of general endotracheal anesthesia a
naso‐gastric tube and urinary catheter are inserted. The patient is placed in lithotomy
position with arms adducted and padded. The table is placed in 25° Trendelenburg
position during the cystectomy and lymph node dissection. For the urinary diversion the
Trendelenburg position is decreased to 15°. Shoulder pads should be avoided due to
high risk for plexus damages.
Equipment
The technique is challenging, requiring conventional laparoscopic infrastructure as well
as an assistant with high skills in conventional laparoscopy. Standard laparoscopic
surgical equipment with some extra instruments is required (Ligasure (Tyco healthcare),
surgical endoscopy clip applicators 5 – 10 mm, laparoscopy endo‐catch bags,
laparoscopy stapler for intestinal stapling).
Surgical Steps
Surgical Step Lens Right Left Robotic Fourth Right
Robotic
文档评论（0）