结扎速血管闭合系统

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,专业：泌尿外科,学位申请人：江先汉,导师：黄健 教授,沙巴棕提取物,施通根治疗良性前列腺增生症的临床研究,The Clinical Research on Treatment of Benign Prostate Hyperplasia with Sabal Serrulata ExtractStrogen,专业：泌尿外科,学位申请人：江先汉,导师：黄健 教授,沙巴棕提取物,施通根治疗良性前列腺增生症的临床研究,The Clinical Research on Treatment of Benign Prostate Hyperplasia with Sabal Serrulata ExtractStrogen,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,Hem-,o-lok,PK System,LigaSure,TM,Vessel Sealing System,图,1-2-10,结扎速血管闭合系统,Ultracision,-Harmonic Scalpel,Patiens,position and,trocar,site,The Major Steps of the Procedure,Step 1:,Pelvic,lymphadenectomy,Step 2,:Dissection,of seminal vesicle and,Denonvelias,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 2:,Dissection of seminal vesicle,opening,Denonvelias,fascia,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 5:,Dividing the urethra,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,Denonvelias,fascia and separating rectum from prostate,Dividing lateral,peadicle,close to the prostate,Transecting the urethra while pulling up the prostate apex,How to deal with the DVC,Clearly exposing the prostate apex,Suture,ligating,and transected with scissors,Different techniques:,Ligasure,PK forceps,Hem-o-lock,Endo-GIA,Different methods in dividing the lateral,paedicles,LigaSure,PK Forceps,Endo-GIA,Harmonic scalpel,How to avoid the tumor seeding,Avoidingbladder,wall perforation,Dont transgressing the tumor boundaries,Blocking up the bladder neck before transecting,uretha,Step 6:,Removal the,spacimen,and,neobladder,construction,The technique of,Extracorporeal,formation of,neobladder,5 cm of midline,subumbilical,skin incision,M shape,ileal,pouch,Implantation of,ureters,directly to the posterior wall of the pouch by means of,ureteral,half nipple.,Different techniques in formation of,neobladder,Intracorporeally,or,extracorporeally,Reconstruction:,Studer,pouch,hemi-,kock,pouch,T pouch,M pouch,Implantation of,ureters,:,ileal,chimney,ileal,nipple,extramural serous-lined tunnels,mucosal,sulcus,ureteral,nipple,Studer,pouch T pouch Hemi-,kock,pouch,ileal,chimney,ileal,nipple,extramural serous-lined tunnels,Mucosal,sulcus,Ureteral,nipple,Step 7:,Neobladder,-,urethra,anastomosis,Two running sutures,technique,Tips and tricks in,Neobladder,-,urethra,anastomosis,A traction stitch to relieve the tension,Changing to head-up position,Two running suture technique better than interrupted,or running suture technique.,Attention:the catheter out side the,neobladder,Summary,The Surgical procedures of LRC-OIN can be improved by reasonable sequence,standard maneuver and correct use of instruments.,hanks！,