Session 8 Metastatic Castrate Resistant Prostate Cancer

Conference Name: Precision Management of Prostate Cancer

Conducted by: Kokilaben Dhirubhai Ambani Hospital & Robotic Urology Forum

Surgeon(s)/Speaker(s): Chairpersons: Dr. Anshu Sharma, Dr. Haresh Thummar, Dr. Anup Kumar

Surgical Procedure: Urology-Prostate

Location: Kokilaben Dhirubhai Ambani Hospital and research Institute Mumbai


1. Preoperative check list : *Adequate hydration *Antibiotics *Consents *Checking all the machines *Checking instruments *Checking CMG report

2. Anesthesia : * Spinal anesthesia* Good hydration

3. Cystoscopy to asses the prostate : Cystoscopy to asses the prostate, the position of the veru montanum, to rule out stones in the bladder

4. Passage of the resectoscope. : Passage of the resectoscope.

5. Markings near the veru : *Creating a passage starting at 6 o'clock position *Vaporizing till the capsule [white tissue] *Going all around vaporizing

6. Resecting few pieces for biopsy : *Resecting few pieces for biopsy *Hemostasis *Placement of 3 way catheter *Irrigation

port positions

1. Patient Position for TVP : * Lithotomic Position * Electrocautery machine: 400 watts pure cut for vaporization & 200 watts for resection


1. Preoperative investigations : lab parameters: routine: : hb, cbc, sr creat, urine r/m, bld grp, pt, ptt, platelet, hiv, hbsag :new: blood sugar random (fasting and postprandial, if diabetic) :new:if partient has ckd: then urea, creatinine, na, k :new: coagulation profile :new: usg abdomen and pelvis :new: psa if necessary :new: phycician opinion and other inv as directed by physician like: chest x-ray, ecg, echocardiogram :new: abdominal ultrasound examination

2. Preoperative measures : hospitalized one day prior in night :new:attachment of the diathermy plate :new:padding of the pressure points :new:lithotomy position :new:dose of prophylactic antibiotic at the time of induction of anaesthesia :new:anti-embolic stockings / placement of an intermittent compression device on the legs if necessary

3. Postoperative measures : monitoring of temperature, pulse and blood pressure :new:allow the patient liquids and diet after 3-4 hours :new:intravenous fluids for the first 6 - 12 hours :new:catheter removal on day 2,3 or 4 depending on bleeding and whether the patient has passed motion or not

4. Warning signs in the postoperative period : patient feels unwell anytime :new:hematuria :new:tachycardia :new:hypotension :new:fever

Surgical Instruments

1. Harmonic Scalpel

2. Specimen extraction Device

3. Harmonic Ultracision

4. Laparoscopic clip appliers

5. Suction source and tubing

6. 5mm Needle Holder

7. 5mm Maryland forceps

8. Atraumatic grasper forceps

9. light source

10. PDS II- 3-0

11. Cystoscopy Sheath

12. Hysteroscope

13. Cystoscope