7 - E-Lib FK UWKS

More documents

Recommendations

Info

Modular Training in EERP Fig. 12.1. a Positioning of the Veress needle. Note that there is no actual umbilicus in the pig. The arrow marks the penis. Two Backhaus clamps are used to facilitate insertion. b Trocar place- Fig. 12.2. a View into the pelvis of the pig after trocar placement. The bladder should be emptied through a percutaneous puncture or by direct incision of the bladder wall. Urethral catheterisation is almost impossible. b The first exercise is the niques in pulsating tissue. A dry lab could never offer training in conditions so close to reality [10, 13–19]. Figures 12.1–12.4 show the structured wet lab programme that we follow in our institution during our training courses at the International Training Center of Urologic Laparoscopy in Leipzig. An alternative to the animal model is the pulsatile organ perfused (POP) trainer (Optimist, Austria) Chapter 12 171 ment for pelvic surgery in pigs. The position of trocars mimics that of EERPE in human even though only a transperitoneal prostatectomy is possible in pigs fixation of the bladder to the abdominal wall to train suturing under live conditions. In this figure fixation has already been performed. This allows easy access to the pelvic lymph nodes and seminal vesicles simulating in vivo conditions. POP trainers are equipped with porcine organ systems and perfused with a red fluid to enhance the realism of organ preparation, dissection and suturing techniques. Animal models are useful in training novice or intermediate-level laparoscopic trainees. However, the trainers should always consider the risk of trainees forming a false impression of their skills when work-
12 172 Fig. 12.3. a Pelvic lymphadenectomy. Note that the peritoneal reflection is very thin and there is no retroperitoneal fat. Traction is exerted on the lymph node and dissection is performed with the aid of a SonoSurg device and cold scissors. b Freeing the seminal vesicles. As in transperitoneal prostatectomy the Fig. 12.4 a Anterior bladder neck dissection. The bladder neck dissection starts with a ventral opening of the bladder neck. For training purposes it is more important to have an appropriate urethral stump for the anastomosis than a complete prostate resection. If the trainee does not feel ready to do the entire prostatectomy, an easy exercise is to suture only this ventral incision. b Anastomosis. As in humans we start with the posterior part of the anastomosis using a 2–0 Polysorb on a GU-46 needle. A Chapter 12 J.-U. Stolzenburg et al. procedure starts with freeing of the seminal vesicles after incision of the peritoneum. The dissection should be performed with caution because there are numerous small vessels in the region. Note that the prostate is very small in the young pigs used during the courses (25–35 kg) 10-cm segment of a thin connecting infusion line tube is used to guide the stitch at the urethra (it is impossible to catheterise male pigs transurethrally). The ventral part of the anastomosis is performed with the tube in both the urethra and the bladder. In general the anastomosis in pigs tends to be more difficult than in humans due to the small available space in the pig’s pelvis. This provides a very good training model
Page 2 and 3:
J.-U. Stolzenburg • Matthew T. Ge
Page 4 and 5:
Stolzenburg, Jens-Uwe, MD, FRCS (Ed
Page 6 and 7:
Preface Endoscopic/laparoscopic ext
Page 8 and 9:
Contents 9 Haemostasis in Radical P
Page 10 and 11:
II John, Hubert Andreas, PD Dr. med
Page 12 and 13:
List of Abbreviations a external il
Page 14 and 15:
Historical Aspects of Laparoscopy a
Page 16 and 17:
Historical Aspects of Laparoscopy m
Page 18 and 19:
Historical Overview of Robotic Radi
Page 20 and 21:
Historical Overview of Robotic Radi
Page 22 and 23:
2 Surgical Neuroanatomy of the Male
Page 24 and 25:
2 14 Table 2.1.1. (continued) Publi
Page 26 and 27:
2 16 2.1.4 show that the cavernosal
Page 28 and 29:
2 18 penetrates the suspensory liga
Page 30 and 31:
2 Inter- and Intrafascial Dissectio
Page 32 and 33:
2 22 Chapter 2.2 J.-U. Stolzenburg
Page 34 and 35:
2 The Muscular Systems of the Bladd
Page 36 and 37:
2 26 Fig. 2.3.2. a Three-dimensiona
Page 38 and 39:
2 28 sphincter as a rhabdosphincter
Page 40 and 41:
2 30 one third of the prostate. Thu
Page 42 and 43:
3 Recommended set of instruments fo
Page 44 and 45:
3 34 Hand Instruments Bipolar Force
Page 46 and 47:
3 36 The Tower Components/Devices C
Page 48 and 49:
3 38 3.2.3 Highlighting Hidden Tiss
Page 50 and 51:
4 40 The indications for endoscopic
Page 52 and 53:
4 42 Fig. 4.1. Postoperative appear
Page 54 and 55:
4 44 4.9 Atypical Size and Shape of
Page 56 and 57:
4 46 Fig. 4.6. a, b Postprostatecto
Page 58 and 59:
Anaesthesia Considerations in Radic
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Pelvic Lymphadenectomy in the Manag
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Technique of Endoscopic Extraperito
Page 76 and 77:
Technique of EERPE - Step by Step C
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Technique of EERPE - Step by Step 7
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
7.5 Apical Dissection Technique of
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
7.6 Anastomosis Technique of EERPE
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129: Technique of EERPE - Step by Step C
Page 130 and 131: Troubelshooting Jens-Uwe Stolzenbur
Page 132 and 133: Troubelshooting needle is extracted
Page 134 and 135: Troubelshooting fibres and neurovas
Page 136 and 137: Troubelshooting Fig. 8.4. Retrograd
Page 138 and 139: Troubelshooting Fig. 8.6. Normal cy
Page 140 and 141: Troubelshooting Fig. 8.10. Minor le
Page 142 and 143: Troubelshooting and sclerotherapy c
Page 144 and 145: 9 136 9.1 Introduction Adequate hae
Page 146 and 147: 9 138 Santorini plexus [3]. Neverth
Page 148 and 149: 9 140 9.6.3 Human Fibrinogen 9.6.5
Page 150 and 151: 9 142 5. Harrell AG, Kercher KW, He
Page 152 and 153: 10 144 Chapter 10 The extraperitone
Page 154 and 155: 10 146 Chapter 10 H. John ∙ M. T.
Page 160 and 161: 10 152 The fascia of Denonvilliers
Page 168 and 169: The Need for Classification of Comp
Page 170 and 171: The Need for Classification Table 1
Page 172 and 173: The Need for Classification Recentl
Page 174 and 175: The Need for Classification servati
Page 176 and 177: Modular Training in Endoscopic Extr
Page 180 and 181: Modular Training in EERP ing in wet
Page 182 and 183: Modular Training in EERP es. It was
Page 184 and 185: References Modular Training in EERP
Page 186 and 187: 13 Inpatient Rehabilitation of Post
Page 188 and 189: 13 182 The pelvis should be moved s
Page 190 and 191: 13 184 Fig. 13.1.5. Transsphincteri
Page 192 and 193: 13 186 15. Kielb S, Dunn RL, Rashid
Page 194 and 195: 13 188 derwent bilateral nerve-spar
Page 196 and 197: 13 190 bility and/or significantly
Page 198 and 199: 13 192 group II, who had used 50-10
Page 200 and 201: 13 194 PDE-5 inhibitor. This rehabi
show all

7 - E-Lib FK UWKS

Create successful ePaper yourself

Delete template?

Save as template?