Self-retraction clamp for dissection of the posterior prostatic fossa during radical retropubic prostatectomy.

Abstract

Dissection of the posterior prostatic fossa is a critical part of radical retropubic prostatectomy (RRP). Two main goals during this portion of surgery are 1. to identify the correct plane on the anterior wall of the rectum to ensure all layers of Denonvilliers fascia are excised, and 2. to avoid trauma to the neurovascular bundle. After resection of the anterior urethra, the Foley catheter is brought through, clamped and divided, followed by incision of the posterior urethral wall. With the aid of a hemostat clamp on the divided Foley catheter, the prostate is retracted cranially to dissect the lateral pelvic fascia and identify the neurovascular bundle. However, manual cranial retraction of the prostate is imprecise; too much retraction can damage the neurovascular bundle, and too little retraction does not delineate the fascial planes between the prostate and the rectum. Therefore, a self-retraction prostate clamp was designed to enable the surgeon to apply constant traction on the Foley catheter during dissection of the posterior prostatic fossa during RRP. (The prostate self-retraction clamp can be purchased from: J Hugh Knight Instrument Company, 226 S. Villere St., New Orleans, LA 70112, 504-524-2797.)