UROLOGIC SURGERY (see Chapter 54 )

Transurethral Resection of the Prostate

In 1995, Nathan and Wickham^[63] published their results of a coring device used to assist in transurethral resection of the prostate (TURP). Traditionally, a resectoscope containing a cutting tungsten wire at its distal end is inserted into the urethra. As energy passes through the tungsten wire, it cuts into prostate tissue. Continuous flow of nonelectrolytic solution is required to promote visibility. Coagulation electrocautery helps in hemostasis but may prolong the procedure. Unfortunately, prolonged resections lead to resorption of this fluid and produce dilution hyponatremia.

The Puma robot has been used to resect prostate tissue safely. ^[64] The safety of the device is derived from a steel circular frame that restricts and confines the robot to a precise arc of resection. The frame acts as a safety fixture that prevents the surgeon from resecting outside the bounds of the frame. Information about the size of the prostate is obtained from an operative transurethral ultrasound inspection. These data are used to construct a three-dimensional image of the entire prostate. Limits of resection, which usually amount to 38% of the prostate gland volume, are programmed into a computer for reference. ^[65] Such procedures can be done more quickly by the robotic instrument, and because hemostasis is done only once at the end of the procedure, there is less time for absorption of irrigation fluid.