A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery
A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery
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DOI：
10.1016/j.eururo.2010.06.008
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发表时间：
2010-09-01
期刊：
影响因子：
23.4
通讯作者：
Bocciardi, Aldo Massimo
中科院分区：
文献类型：
--
作者：
Galfano, Antonio;Ascione, Assunta;Bocciardi, Aldo Massimo
机器人辅助腹腔镜前列腺切除术（RALP）已被广泛传播，改变了前列腺的外科解剖学知识。本研究的目的是证明一种新的纯筋膜内入路的可行性。Bocciardi入路通过道格拉斯间隙，遵循完全的筋膜内平面，不解剖前室，其中包括神经血管束，Aphrodite面纱，骨盆内筋膜，Santorini丛，耻骨尿道韧带，在这个病例系列中，我们介绍了我们的前五名接受Bocciardi方法治疗RALP的患者。我们报告的结果，我们的技术在三个病人后，两次不成功的尝试。无围手术期严重并发症。病理分期pT2c 2例，pT2a 1例，无手术切缘阳性。在取出导管后的第二天，3名患者中有2名报告使用了一个小的安全垫，1名患者出院时没有使用任何安全垫。1例患者在拔除导管后第二天报告勃起，与传统RALP相比，其结果更好的解剖学基础是强有力的，但需要精心设计的研究来评估我们技术的优势。(C)2010年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Robot-assisted laparoscopic prostatectomy (RALP) has been disseminated widely, changing the knowledge of surgical anatomy of the prostate. The aim of our study is to demonstrate the feasibility of a new, purely intrafascial approach.The Bocciardi approach for RALP passes through the Douglas space, following a completely intrafascial plane without any dissection of the anterior compartment, which contains neurovascular bundles, Aphrodite's veil, endopelvic fascia, the Santorini plexus, pubourethral ligaments, and all of the structures thought to play a role in maintenance of continence and potency.In this case series, we present our first five patients undergoing the Bocciardi approach for RALP. We report the results of our technique in three patients following two unsuccessful attempts. No perioperative major complication was recorded. Pathologic stage was pT2c in two patients and pT2a in one patient, with no positive surgical margin. The day after removing the catheter, two of the three patients reported use of a single, small safety pad, and one patient was discharged without any pad. One patient reported an erection the day after removing the catheter.The anatomic rationale for better results compared with traditional RALP is strong, but well-designed studies are needed to evaluate the advantages of our technique. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.