Robotic assisted laparoscopic radical cystoprostatectomy: Operative and pathological outcomes
Robotic assisted laparoscopic radical cystoprostatectomy: Operative and pathological outcomes
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DOI：
10.1016/j.juro.2007.05.040
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发表时间：
2007-09-01
影响因子：
6.6
通讯作者：
Wallen, Eric M.
中科院分区：
文献类型：
--
作者：
Pruthi, Raj S.;Wallen, Eric M.
目的：最近的小病例系列报道了机器人辅助腹腔镜根治性膀胱切除术。我们报告我们的初步经验，机器人辅助腹腔镜根治性膀胱切除术，评估围手术期和病理结果，这种新的procedure.Materials和方法：共20名男子进行了机器人辅助腹腔镜根治性膀胱切除术和体外尿流改道临床本地化膀胱癌。在这一系列的结果指标评价手术变量，住院恢复，病理结果和并发症发生率。比较了24名性别匹配的男性谁经历了开放式procedure在同一period.Results：平均患者年龄为62.3岁（范围54至76）。10例患者接受了回肠导管分流术，10例接受了原位新膀胱术。所有病例均在体外进行尿流改道。机器人病例的平均手术时间为6.1小时，包括最近10例病例的5.2小时。这比接受开放手术的患者要长（3.8小时）。平均手术失血量为313 ml，明显低于接受开放性膀胱切除术的患者（588 ml）。手术病理pT2以下14例，pT3 4例，N+2例。在任何情况下都没有意外进入膀胱或积极的手术切缘。平均切除19个淋巴结。平均排气时间为2.1天，平均排便时间为2.8天，明显短于接受开放手术的男性。术后第4、5、8天分别有16、3、1例出院回家。5例患者中共有6例术后并发症（30%）。结论：我们的初步经验与机器人辅助腹腔镜根治性膀胱癌切除术似乎是有利的，可接受的手术，病理和短期的临床结果。随着我们经验的增加，我们希望继续完善我们的手术技术，减少手术时间。
Purpose: Recent small case series have now been reported for robotic assisted laparoscopic radical cystoprostatectomy. We report our initial experience with robotic assisted laparoscopic radical cystoprostatectomy, evaluating the perioperative and pathological outcomes of this novel procedure.Materials and Methods: A total of 20 men underwent robotic assisted laparoscopic radical cystoprostatectomy and extracorporeal urinary diversion for clinically localized bladder cancer. Outcome measures evaluated in this series were operative variables, hospital recovery, pathological outcomes and complication rate. Comparisons were made to 24 gender matched men who underwent an open procedure during the same period.Results: Mean patient age was 62.3 years (range 54 to 76). Ten patients underwent ileal conduit diversion and 10 received an orthotopic neobladder. In all cases urinary diversion was performed extracorporeally. Mean operative time for robotic cases was 6.1 hours, including 5.2 hours in the most recent 10 cases. This was longer than in patients undergoing an open procedure (3.8 hours). Mean surgical blood loss was 313 ml, which was significantly less than in those undergoing open cystectomy (588 ml). On surgical pathology 14 cases were pT2 or less, 4 were pT3 and 2 were N+. In no case was there inadvertent entry into the bladder or positive surgical margins. A mean of 19 lymph nodes was removed. Mean time to flatus was 2.1 days and mean time to bowel movement was 2.8 days, which was significantly shorter than in men undergoing an open procedure. Of the patients 16, 3 and 1 were discharged home on postoperative days 4, 5 and 8, respectively. There were a total of 6 postoperative complications (30%) in 5 patients.Conclusions: Our initial experience with robotic assisted laparoscopic radical cystoprostatectomy appears to be favorable with acceptable operative, pathological and short-term clinical outcomes. As our experience increases, we expect to continue to refine our surgical technique and decrease operative time.