Vattikuti Institute Prostatectomy: Technical Modifications in 2009
Vattikuti Institute Prostatectomy: Technical Modifications in 2009
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DOI：
10.1016/j.eururo.2009.04.032
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发表时间：
2009-07-01
期刊：
影响因子：
23.4
通讯作者：
Agarwal, Piyush K.
中科院分区：
文献类型：
--
作者：
Menon, Mani;Shrivastava, Alok;Agarwal, Piyush K.
背景：自从我们最后一次发表我们的机器人前列腺切除术技术以来，我们介绍了三项技术改进：保留SuperVeil神经，经皮耻骨上管(PST)膀胱引流，以及在选定的患者中优先于髂外淋巴结对闭孔和髂内结节进行有限的结节清扫。目的：描述选择标准，解释三种技术，并评估功能和肿瘤学结果。设计、背景和对象：2006年至2008年由一名外科医生进行的1151例前列腺癌根治术的单一机构研究。外科手术：SuperVeil神经保留技术将神经从11点位置保留到1点位置。膀胱的引流是用PST而不是导尿管。对于中等风险的低风险疾病，有限的淋巴清扫主要集中在髂内和闭孔淋巴结，不包括髂外淋巴结。测量：勃起功能和患者舒适度通过第三方发放的问卷进行评估。结果和限制：在术后6-18个月，94%尝试性交的男性成功，男性性健康问卷(Shim)的中位数为18分(满分25分)。PST膀胱引流术后患者不适感减轻，术后第2天视觉模拟评分为2，术后第6天视觉模拟评分为0。改良的淋巴清扫术收获的结节很少，但在低风险分层的患者中，它使阳性结节的发生率提高了13倍(6.7%比0.5%)。结论：在这项单一机构、单一外科医生的研究中，这些改良措施改善了勃起功能结果，减少了导管相关的不适，并提高了阳性结节的检测率。(C)2009年欧洲泌尿外科协会。爱思唯尔出版，版权所有。
Background: Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients.Objective: To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results.Design, setting, and participants: Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon.Surgical procedure: The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- of intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes.Measurements: Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist.Results and limitations: At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; Visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%).Conclusion: In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.