Case report
Use of mechanical stapler to achieve haemostasis of Santorini’s venous complex during laparoscopic radical prostatectomy

Introduction: Dissection and transsection of the dorsal venous complex is an important step in laparoscopic radical prostatectomy. We herein present a technical modification facilitating this manoeuvre with the application of a mechanical suturing device. The aim of the study: Feasibility study of mechanical suturing stapler (ETS 45mm, Ethicon) function in terms of its application for dorsal vein complex ligation during laparoscopic radical prostatectomy. Material and methods: In three consecutive patients who underwent laparoscopic radical prostatectomy an endoscopic gastrointestinal stapler (ETS 45mm, Ethicon) was used. In the course of operation after exposing the anterior surface of the prostate, disjointing of endopelvic fascia and dissection of the apex the ETS 45mm (Ethicon) stapler was introduced and placed on the Santorini complex together with preserved puboprostatic ligaments. When a Beniquet sound was placed in the uretha for its protection the transsection of the venous complex and ligaments could be accomplished and free access to the urethra was obtained. Results: The manoeuvre of transsection of Santorini’s plexus was completed bloodlessly and it lasted approximately 3 minutes. No additional technical problems were encountered. On histopathological examination none of the patients had positive surgical margins at the apex. We observe a gradual return of urinary continence in all patients. Conclusions: Application of a mechanical stapling device during laparoscopic radical prostatectomy is feasible and may result in reduction of blood loss and operating time