Application of a fixed retractor system to facilitate laparoscopic radical prostatectomy.

Abstract

We report application of a fixed retractor system for reduction of the steep Trendelenberg position required to achieve deep pelvic access for laparoscopic radical prostatectomy. A fixed retractor system consisting of a flexible arm that can be locked in position and an expandable 5 mm laparoscopic retractor were used to gain exposure to the deep pelvis. We describe in detail our technique for laparoscopic radical prostatectomy incorporating the fixed retractor system to facilitate each step of the procedure. Application of the fixed retractor system reduced steep Trendelenberg position requirements for adequate pelvic exposure from 25 to 15 degrees in our most recent 24 laparoscopic radical prostatectomies. Furthermore, application of the retractor system reduced the need for an experienced laparoscopic assistant. Application of the fixed retractor system for laparoscopic radical prostatectomy eliminated the requirement for the steep Trendelenberg position to achieve access to the deep pelvis. Visceral structures were safely and indefatigably retracted from the operative field. The technique also allowed the surgical assistant to assist the surgeon with local retraction and aspiration.