Abstract
BackgroundWe describe a safe and easily reproducible technique to control Santorini plexus during radical retropubic prostatectomy (RRP) which uses simple digital dissection.MethodsWe retrospectively reviewed 56 consecutive patients who underwent RRP for clinically localised prostate cancer from November 2008 to November 2010. Santorini plexus was isolated and secured in all patients using a new technique of simple digital dissection in which the index finger is used not to only localize the catheter inside the urethra, but also to develop the right plane between Santorini plexus and urethra. This is obtained by gentle bilateral digital dissection through the lateral aspects of periprostatic fascia which are eventually breached by the fingers, developing a right plane just above the urethra. Santorini plexus is then easily ligated and divided. Indicators of outcomes included estimated blood loss, transfusion requirements, operative time, positive margins and complication rates of the technique.ResultsThe maneuver was successful in 53/56 (95%) patients. Mean (range) blood loss and overall operative time for RRP were 620 ml (100–1500) and 130 min. (80–190), respectively. Transfusion rate was 8,9% (5/56). Positive surgical margin rate was 14% (8/56). No complication related to the employed technique was recorded.ConclusionsDigital dissection of Santorini plexus during RRP is simple and easily feasible. It speeds up the process of finding the right plane just above the urethra allowing good haemostasis in the surgical field and proper apical dissection.
Highlights
We describe a safe and reproducible technique to control Santorini plexus during radical retropubic prostatectomy (RRP) which uses simple digital dissection
Procedure follows the classical steps of retrograde radical retropubic prostatectomy
Utility We describe an reproducible technique which, to the procedure described by Namiki et al, allows securing of dorsal vein complex (DVC) during RRP by the simple digital development of the right plane between urethra and DVC allowing an easy and safe clamp passage for its ligation
Summary
We describe a safe and reproducible technique to control Santorini plexus during radical retropubic prostatectomy (RRP) which uses simple digital dissection. Retropubic radical prostatectomy (RRP) has been considered as gold standard surgical treatment for localised prostatic cancer [1]. The use of minimally invasive techniques has increased in recent years, RRP still represents the most frequently employed surgical treatment in most countries [2]. Control of the dorsal vein complex (DVC) or Santorini plexus remains one of the most challenging steps of the procedure to reduce blood loss, avoid damage to the sphincteric muscle and maximize the chance of cure It is often accomplished by blindly passing a clamp between
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