Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: Initial experience
Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: Initial experience
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DOI：
10.1016/j.eururo.2008.04.011
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发表时间：
2008-09-01
期刊：
影响因子：
23.4
通讯作者：
Dasqupta, Prokar
中科院分区：
文献类型：
--
作者：
Murphy, Declan G.;Challacombe, Ben J.;Dasqupta, Prokar
背景：机器人技术在腹腔镜前列腺切除术中的应用已经很成熟。机器人辅助腹腔镜根治性膀胱切除术（RARC）的情况就不一样了，全世界只有少数几个中心在做这种手术。目的：介绍运用达芬奇手术系统进行该手术的技术和经验。设计、环境和参与者：从2004年到2007年，23名患者在我们的机构接受了RARC和尿分流。外科手术：我们报告了RARC技术的发展，包括后路剥离、外侧椎弓根控制、前路剥离和淋巴结切除，然后再进行回肠输尿管转移或体外重建Studer袋。测量：前瞻性记录人口统计学和围手术期数据。每隔3- 6个月对肿瘤和功能结果进行评估。结果和局限性：迄今为止，23例患者在我院接受了该手术。其中19例存在回肠袢尿路转移，4例适合行Studer膀胱重建术。平均总手术时间正负（+/-）标准差（SD）为397±83.8 min。平均失血量SD为278 +/- 229 ml， 1例患者需要输血。所有患者手术边缘清晰，平均SD为16 +/- 8.9淋巴结。并发症发生率为26%。在平均随访SD为17 +/- 13（范围4-40）个月时，一名患者死于转移性疾病，另一名患者因转移而存活。其余21例患者存活，无复发。结论：在少数开展此类手术的中心，RARC仍然是一种正在发展的手术。我们的初步经验证实，它是可行的，具有可接受的发病率和良好的短期肿瘤结果。(C) 2008年欧洲泌尿外科协会。Elsevier B.V.版权所有。
Background: The use of robotic technology for laparoscopic prostatectomy is now well established. The same cannot yet be said of robotic-assisted laparoscopic radical cystectomy (RARC), which is performed in just a few centres worldwide.Objective: We present our technique and experience of this procedure using the da Vinci surgical system.Design, setting, and participants: From 2004 to 2007, 23 patients underwent RARC and urinary diversion at our institution.Surgical procedure: We report the development of our technique for RARC, which involves posterior dissection, lateral pedicle control, anterior dissection, and lymphadenectomy prior to either ileal conduit urinary diversion or Studer pouch reconstruction performed extracorporeally.Measurements: Demographic and perioperative data were recorded prospectively. Oncologic and functional outcomes were assessed at 3- to 6-mo intervals.Results and limitations: To date, 23 patients have undergone this procedure at our institution. Of those, 19 had ileal loop urinary diversion and 4 were suitable for Studer pouch reconstruction. Mean total operative time plus or minus (+/-) standard deviation (SD) was 397 +/- 83.8 min. Mean blood loss SD was 278 +/- 229 ml with one patient requiring a blood transfusion. Surgical margins were clear in all patients with a median SD of 16 +/- 8.9 lymph nodes retrieved. The complication rate was 26%. At a mean follow-up SD of 17 +/- 13 (range 4-40) mo, one patient had died of metastatic disease and one other is alive with metastases. The remaining 21 patients are alive without recurrence.Conclusions: RARC remains a procedure in evolution in the small number of centres carrying out this type of surgery. Our initial experience confirms that it is feasible with acceptable morbidity and good short-term oncologic results. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.