tailieunhanh - Laparoscopic urologic surgery in malignancies - part 6

Chúng tôi thực hiện hai mạch máu tiếp hợp với nhau với chỉ khâu bị gián đoạn, bằng cách sử dụng một resorbable 3-0 trên một kim RB1. Tất cả chỉ khâu được gắn intracorporeally. Ba khâu đầu tiên sau, đặt tại giờ vị trí 5, 6 và 7, trong ra ngoài niệu đạo và ngoài trên cổ bàng quang. Những khâu vết thương do đó được liên intraluminally. | 144 K. Touijer et al. racket reconstruction is required. We perform the anastomosis with interrupted sutures using a 3-0 resorbable on an RBI needle. All the sutures are tied in-tracorporeally. The first three sutures are posterior placed at the 5 6 and 7 o clock positions going inside-out on the urethra and outside-in on the bladder neck. These sutures are therefore tied intraluminally. Four other sutures are symmetrically placed at the 4 and 8 then the 2 and 10 o clock positions and tied outside the lumen. Three final anterior stitches are placed at the 11 12 and 1 o clock positions and placed symmetrical to the posterior stitches. Once the sutures are tied the Foley catheter is inserted. The bladder is filled with 180 cc of saline to ascertain a watertight anastomosis and confirm the correct position of the catheter. Morbidity Blood Loss The average estimated blood loss in the series from Montsouris was 380 ml and an allogeneic transfusion rate of with no autologous blood transfusion for all 550 patients. In the last 350 patients the mean blood loss and transfusion rate declined to 290 ml and 8 . In a contemporary series of transperito-neal LRP at the MSKCC the average blood loss is 300 ml and the allogeneic transfusion rate is 5 similar to that reported from other centers worldwide 9-11 . For instance Eden et al. reported a mean blood loss of 313 ml and an allogeneic transfusion rate of 3 in a series of 100 transperitoneal LRPs 12 . This contrasts with the experience from Heidelberg which reported an average blood loss of 1 100 ml and a transfusion rate of 30 for their initial 219 patients and 800 ml with transfusion rate for the last 219 patients. The authors attributed the relatively higher blood loss and transfusion rate in their series to difficulties encountered with the ascending technique 13 . All these data should be confronted to those reported during radical retropubic prostatectomy RRP where the blood loss remains relatively significant .

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