Positioning during radical retropubic prostatectomy

[stevierae]

Do you guys usually place the safety strap just above the knees, or at mid-calf?

Do you spread (and leave) the legs slightly apart, like a "V", as you might when you do a fem-pop, (so that you can access the groin prn) or do you leave them in straight adduction, as you would any other routine supine position abdominal surgery (i.e., chole?

Do you put anything under the coccyx for slight elevation, such as a gel roll or IV bag?

Do you use TEDS and SCDs intraop, or does it vary according to surgeon's preference?

I am seeing so many variations lately depending to institution that I am starting to wonder why......that is, the rationale of the various differences, or if there is any other than the idiosyncracies of the various urologists involved...

[grimmy, RN]

why the bean bag? does the patient go into trendelenberg or reverse trendelenberg? and how do you fit the safety strap over the patient in lithotomy and not have the strap interfere with the surgical field?

sorry but i'm having a hard time visualizing this...

btw, how does the davinci robot work? i've heard of it but we don't use robotics in our or. i'm assuming they tried it but it didn't work for them.

typically, the davinci works like the surgeon...but on a much smaller level. this sort of machine was really pushed by our urology chief, and it is used almost exclusively for prostatectomies at uva. it is highly publicized around the area, and the dept hired on a fellow to know that robot inside and out, as well as run the pr for it. basically, the robot is about 7 feet tall with the motors attached to laparoscopic arms. the surgeon never scrubs. the assistant scrubs, drapes the robot and pt, creates the laparoscopic incisions, aims and positions the robotic arms. after that, it's mostly up to the surgeon. the assistant will change the instruments on the arms and close. the surgeon sits in a little booth with his arms and feet working levers that move the robotic arms. it's actually a little comical to see a bunch of medical students sitting at one side of the or with the 3-d glasses on in front of a movie screen...the entire setup must be done in 3 dimensions - that's how the surgeon sees it in the booth. he/she is also mic'ed. the finer points (and i am sure there are many) are beyond my knowledge. as i said, there is a team that specializes in the davinci, and i am not on that team. when i oriented, i had to learn how to circulate a robot case in the event that a team member called out. i hope that helped to give you a little background.

[ShirleyM]

typically, the davinci works like the surgeon...but on a much smaller level. this sort of machine was really pushed by our urology chief, and it is used almost exclusively for prostatectomies at uva. it is highly publicized around the area, and the dept hired on a fellow to know that robot inside and out, as well as run the pr for it. basically, the robot is about 7 feet tall with the motors attached to laparoscopic arms. the surgeon never scrubs. the assistant scrubs, drapes the robot and pt, creates the laparoscopic incisions, aims and positions the robotic arms. after that, it's mostly up to the surgeon. the assistant will change the instruments on the arms and close. the surgeon sits in a little booth with his arms and feet working levers that move the robotic arms. it's actually a little comical to see a bunch of medical students sitting at one side of the or with the 3-d glasses on in front of a movie screen...the entire setup must be done in 3 dimensions - that's how the surgeon sees it in the booth. he/she is also mic'ed. the finer points (and i am sure there are many) are beyond my knowledge. as i said, there is a team that specializes in the davinci, and i am not on that team. when i oriented, i had to learn how to circulate a robot case in the event that a team member called out. i hope that helped to give you a little background.

grimmy, thanks for the explanation. i have a better understanding of it now.

[stevierae]

Here's a cool site if any of you are interested--it's free, although you have to register and choose a screen name and password. Virtually any laparoscopic operation is on there in 3-D, just as if you were scrubbed and watching; and they are narrated, step by step. I didn't see a robotic radical prostatectomy, but there is a robotic chole. You can get CEs from the site too (or rather CMEs--you just ask your state board their equivalency in CEs.) I am not certain if they are free, but I intend to take full advantage if they are!

http://www.websurg.com