This is a new and innovative way of performing radical prostatectomy in patients with prostate cancer. The patient is placed on an operating table near a so-called patient unit consisting of a high-resolution camera and three arms containing microsurgical instruments. The surgeon operates the robot from a computer console and views the surgical field on a monitor as magnified 3D images. The operator usually makes a number of incisions between 1 cm to 2 cm wide through which the camera and surgical instruments are inserted into the pelvis. The surgeon’s hand movements are filtered and translated by the robot into very fine and precise movements of the microtools. This markedly increases the precision of prostate removal and reduces the risk of nerve damage and potential development of postsurgical erectile dysfunction.
In the clinic
Abscesses in the ischio-anal fossae
The anal mucosa is particularly vulnerable to injury and may be easily torn by hard feces. Occasionally, patients develop inflammation and infection of the anal canal (sinuses or crypts). This infection can spread between the sphincters, producing intersphincteric fistulas. The infection can tract superiorly into the pelvic cavity or laterally into the ischio-anal fossae.
In the clinic
A hemorrhoid is an engorgement of the venous plexus at or inside the anal sphincter. It is a common complaint and has prevalence of approximately 4% in the United States. Hemorrhoids have a slight genetic predisposition; however, straining during bowel movements, obesity, and sedentary lifestyle can also produce hemorrhoids. The symptoms include irritation, pain, and swelling. Hemorrhoids occurring at the anal verge (distal boundary of the anal canal) are typically called external hemorrhoids. Internal hemorrhoids occur inside the rectum and have a tendency to bleed. Prolapsed hemorrhoids are internal hemorrhoids that pass outside the anal canal and form lumps, which may undergo thrombosis and become painful.
There are many treatments for hemorrhoids, which include ligation above the pectinate (dentate) line using simple rubber bands or surgical excision. Surgery to this region is not without complications and care must be taken to preserve the internal anal sphincter.
In the back of every physician’s mind is the concern that the rectal bleeding or symptoms may not be attributable to hemorrhoids. Therefore, excluding a tumor within the bowel is as important as treating the hemorrhoids.
In the clinic
Emission and ejaculation of semen
In men, emission is the formation of semen, and ejaculation is the expulsion of semen from the penis.
Although erection of the penis is a vascular event generated by parasympathetic nerves from spinal levels S2–S4, the formation of semen in the urethra is caused by the contraction of smooth muscle of the ducts and glands of the reproductive system that is innervated by the sympathetic part of the visceral nervous system. Ejaculation of semen from the penis is through the action of skeletal muscles innervated by somatic motor nerves.
Smooth muscle in the duct system of the male reproductive tract and in the accessory glands is innervated by sympathetic fibers from the lower thoracic and upper lumbar spinal levels (T12, L1,2). The fibers pass into the prevertebral plexus and are then distributed to target tissues. Semen is formed as luminal contents from the ducts (epididymis, ductus deferens, ampulla of the ductus deferens) and glands (prostate, seminal vesicles) are moved into the urethra at the base of the penis by the contraction of smooth muscle in the walls of the structures.