PREOPERATIVE DIAGNOSIS: Intermediate risk prostate cancer
POSTOPERATIVE DIAGNOSIS: Intermediate risk prostate cancer
OPERATIONS PERFORMED: Irreversible electroporation of the prostate
SURGEON: Louis S. Krane, MD
ASSISTANT: ***
DRAINS: A 16-French urethral catheter.
COMPLICATIONS: None
ANESTHESIA: General endotracheal anesthesia
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR PROCEDURE: Mr. *** is a ***-year-old gentleman with a history of favorable intermediate risk prostate cancer found along the right lateral portion of his prostate. The patient was counseled preoperatively regarding treatment options and the patient elected to undergo an irreversible electroporation procedure of his prostate lesion. Of note, the patient had been counseled preoperatively that there was not extensive long-term data regarding treatment of this and the patient subsequently elected to undergo the procedure despite that.
PROCEDURE IN DETAIL: Following obtaining informed consent, the patient was brought back to the operating room. A timeout was performed to ensure the appropriate patient, procedure, site, and side. The patient was placed in supine position. General anesthesia was induced. Subsequently, the patient was placed in dorsal lithotomy position. All pressure points were appropriately padded to prevent compartment syndrome or neuropathy. The patient was prepped and draped in the normal sterile fashion.
At this point in time, a transrectal ultrasound transducer was placed in the
patient's rectum. We were able to identify the entirety of the prostate. We
were able to see a (hypoechoic circular 1.3 cm lesion along the right mid gland peripheral zone), which corresponded to his preoperatively identified MRI lesion. At this point in time, we placed four IRE probes between 1 and 2 cm in distance apart surrounding the lesion. We were greater than 5 mm away from the rectum. We set all of them in a 2 cm margin and could clearly identify the hypoechoic nodule within the 4 lesions in both transverse and sagittal imaging.
At this point in time, we elected to turn on the irreversible electroporation
machine. We checked the impedances and they all appeared to be excellent, and thus, we performed an ablation of the lesion utilizing a total of 100 pulses. We noted excellent destruction of the lesion. At this point, we were able to note a substantial hydrolytic effect surrounding the lesion and at the
conclusion of the procedure, a very hypointense circular lesion corresponding to the patient's tumor was clearly identified on transrectal ultrasound. At this point, the probes were removed. The transducer was removed. A 16-French Foley catheter placed per urethra and this terminated the procedure.
Dr. Louis Spencer Krane was present for and participated in all aspects of this
patient's care.
The patient was brought to the post-anesthesia care unit and discharged home following recuperation. His urethral catheter remain for 72 hours.