After the ports are placed, the patient is placed in a 40° steep Trendelenburg position. It is ensured that the bladder is empty by using the suction irrigator to evacuate the urine within the Foley catheter, since the Foley catheter does not adequately drain the bladder in a steep Trendelenburg position. The sigmoid colon is retracted superiorly by the assistant using the right lateral port. The suction irrigation is used through the lower midline port by the assistant to help with suction during the dissection. There are two peritoneal arches that are evident anteriorly in the rectovesical pouch of Douglas. The lower peritoneal arch is the landmark for dissection of the seminal vesicles (Fig. 37.2). A transverse incision is made at this arch. The vas deferens is held up and dissected towards the prostate. The vas deferens is coagulated with bipolar coagulation or clipped and divided. The assistant then holds the vas deferens anteriorly, exposing the seminal vesicles on either side. After both vasa deferentia are dissected, the seminal vesicles are dissected from the base to the apex, taking care to control the artery to the seminal vesicle with bipolar coagulation before division. After the seminal vesicles and vasa deferentia are dissected on both sides, an incision is made in the Denonvilliers' fascia about 2 mm posterior to the base of the seminal vesicles. Visualization of the perirectal fat identifies the right plane during this dissection (Fig. 37.3). Dissection can then be carried out in that plane towards the prostatic apex.
Should the vas deferens or the seminal vesicles not be readily apparent after incision of the peritoneum in the pouch of Douglas, the vas deferens is identified more laterally along the
Was this article helpful?
You are about to discover the "little-known" techniques, tricks and "mind tools" that will show you how to easily "program" your body and mind to produce an instant, rock-hard erection. Learn how to enjoy all of the control, confidence and satisfaction that comes from knowing you can always "rise to the challenge" ... and never have to deal with embarrassment, apologies, shyness or performance anxiety in the bedroom, ever again.