The Dorsal Vein Complex: Achieving Hemostasis and Proper Setup for Apical Division

Abstract

Management of the dorsal venous complex (DVC) and the setup for division of the apical urethra are critical aspects of the radical prostatectomy. Proper control and division of the DVC allows the procedure to be performed with minimal blood loss and provides excellent exposure of the prostatic apex and urethra, which is essential to avoiding positive surgical margins in this area. Several techniques have been described, and can essentially be categorized into early or late ligation. Early ligation of the DVC is typically performed as soon as the prostatic apex has been exposed after incising the endopelvic fascia. This can be accomplished with either a figure-of-eight suture or an endovascular stapler, and carries the advantage of obtaining early control of potential venous bleeding at the apex. Late ligation is performed only after the prostatic pedicles have been taken and the DVC has already been divided, which allows a running suture closure of the venous complex with excellent visualization of the prostatic apex and urethra. While these techniques are quite different, both are acceptable, easily performed and maintain similar goals: to achieve negative apical margins, to maximize the length of the urethral stump, to preserve the external urinary sphincter, and to obtain reliable hemostasis.