Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes
Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes
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经膀胱机器人辅助根治性前列腺切除术：初步经验和手术结果
DOI：
10.1111/bju.15111
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发表时间：
2020-06-01
影响因子：
4.5
通讯作者：
Wang, Gongxian
中科院分区：
文献类型：
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作者：
Zhou, Xiaochen;Fu, Bin;Wang, Gongxian
芬奇患者术前资料（平均+/-标准差年龄63.4 +/- 8.1岁，体重指数28.6 +/- 5.3 kg/m（2），总前列腺特异性抗原10.8 +/- 4.9 ng/mL和前列腺体积30.6 +/- 14.4 mL，中位数[四分位数间距{IQR}]活检Gleason评分6 [6-7]，和国际勃起功能指数[IIEF]-5分18 [16-20]）。术前评估显示28例cT 2a和7例cT 2b疾病。所有患者术前均能控制（定义为不需要垫或作为预防措施，每天一个干燥垫）。评估手术结果和围手术期并发症。所有患者术后随访至少12个月。结果平均手术时间为150 ± 35 min。估计失血量为100 ± 45 mL。1例患者出现尿路感染，用左氧氟沙星治疗。另一名患者在术后第14天主诉排尿困难，使用琥珀酸索利那新后缓解。术后第7天拔除导尿管。32例患者实现了即刻排尿通畅，3例患者在术后第14天恢复完全排尿通畅。术后病理学证实了24例pT 2a病例、9例pT 2b病例和2例pT 2c病例（中位数[IQR] Gleason评分6 [6-7]）。手术切缘阳性4例（11.4%）。术后3个月行尿道膀胱造影检查，未见尿道狭窄或尿漏。术前和术后6个月进行尿动力学检查：中位数（IQR）最大尿流量为12.2（10.2-14.9）vs 13.7（10.1-15.0）mL/s;膀胱容量385.3（351.3-410.2）vs 370.2（330.1-395.4）mL;排尿期逼尿肌收缩力分别为38.5（27.8-42.3）vs 35.6（28.3-41.3）mmH 2 O。在至少12个月的随访期间，在任何患者中均未观察到生化复发。IIEF-5评分中位数为17分（16-19分）。结论经膀胱入路是RARP的有效替代方法，在选定的患者中，提供了有希望的术后尿路通畅。长期功能和肿瘤学结果需要进一步研究。
Objectives To describe in detail the techniques for transvesical robot-assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer.Patients and Methods Thirty-five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean +/- sd age 63.4 +/- 8.1 years, body mass index 28.6 +/- 5.3 kg/m(2), total prostate-specific antigen 10.8 +/- 4.9 ng/mL and prostate volume 30.6 +/- 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6-7], and International Index of Erectile Function [IIEF]-5 score 18 [16-20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri-operative complications were assessed. All patients were followed up for at least 12 months postoperatively.Results The mean operating time was 150 +/- 35 min. Estimated blood loss was 100 +/- 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty-two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6-7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2-14.9) vs 13.7 (10.1-15.0) mL/s; bladder capacity 385.3 (351.3-410.2) vs 370.2 (330.1-395.4) mL; and voiding phase detrusor contractility 38.5 (27.8-42.3) vs 35.6 (28.3-41.3) mmH(2)O, respectively. During a minimum of 12 months of follow-up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF-5 score was 17 (16-19).Conclusions The transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long-term functional and oncological results require further investigation.