SURGERY FOR UROLOGICAL MALIGNANCIES
Demographic changes resulting in an increasingly elderly
population, together with improved sur-vival rates for patients with urological
cancer fol-lowing radical surgical resections, have resulted in an increase in
the number of procedures performed for prostatic, bladder, testicular, and
renal cancer. The desire for accelerated, less-complicated recovery with
smaller, less painful incisions has prompted the development of laparoscopic
pelvic and abdominal operations, including radical prostatectomy, cystec-tomy,
pelvic lymph node dissection, nephrectomy, and adrenalectomy. Robotic-assisted
technology has increasingly been applied to these procedures over the past
decade.
Many urological procedures are carried
out with the patient in a hyperextended supine posi-tion to facilitate exposure
of the pelvis during pelvic lymph node dissection, retropubic prostatectomy, or
cystectomy ( Figure 31–3). The patient is positioned supine with the iliac
crest over the break in the operating table, and the table is extended such
that the distance between the iliac crest and the costal margin increases
maximally. Care must be taken to avoid putting excessive strain on the
patient’s back. The operating room table is also tilted head-down to make the
operative field horizontal. In the frog-leg position, a variation of the
hyperextended supine position, the knees are also flexed and the hips are
abducted and externally rotated.
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