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.