Kamel Mohamed H, Bissada Nabil K, Diab Nizar Bou, Kaczmarek Anthony T
Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Can J Urol. 2010 Apr;17(2):5114-6.
Radical perineal prostatectomy (RPP) has an important place as a management option for prostate cancer. Herein we describe an adaptation that we found to significantly help the exposure during this procedure.
After opening the urethra, the long Lowsley tractor is changed to the short tractor. Caudal traction facilitates the dissection up to the bladder neck, which is opened. Classically, at this point an umbilical tape or Penrose drain substitutes the short tractor. Because of the limitation in the amount of traction that can be applied without fracturing through the tissue, we have utilized traction sutures placed in both right and left lobes of the prostate instead of the Penrose drain.
Traction on these sutures resulted in excellent exposure and greatly facilitated the posterior dissection of the prostate as well as seminal vesicles dissection.
This small addition to the standard technique of RPP helps with complete dissection of the prostate and seminal vesicles. We recommend replacing the traditional Penrose traction with these sutures placed in the lateral lobes of the prostate.
根治性会阴前列腺切除术（RPP）作为前列腺癌的一种治疗选择具有重要地位。在此，我们描述一种我们发现能在该手术过程中显著帮助暴露术野的改良方法。
打开尿道后，将长的洛斯利牵引器换成短牵引器。向尾侧牵引有助于向上解剖直至打开膀胱颈。传统上，此时会用脐带线或橡皮引流管替代短牵引器。由于在不撕裂组织的情况下可施加的牵引力度有限，我们改为在前列腺左右叶放置牵引缝线，而非使用橡皮引流管。
对这些缝线进行牵引可实现极佳的暴露效果，并极大地便于前列腺的后方解剖以及精囊解剖。
对RPP标准技术的这一微小改进有助于完整解剖前列腺和精囊。我们建议用置于前列腺侧叶的这些缝线取代传统的橡皮引流管牵引。
