Guillonneau B, Vallancien G
Department of Urology, Institut Mutualiste Montsouris, University Pierre et Marie Curie, Paris, France.
J Urol. 2000 Jun;163(6):1643-9. doi: 10.1016/s0022-5347(05)67512-x.
Laparoscopic radical prostatectomy has become standard at our institution based on experience with 260 consecutive cases operated on between January 1998 and December 1999. In view of the favorable short-term outcomes we describe our standardized laparoscopic radical prostatectomy technique.
Two urologists trained in open retropubic radical prostatectomy and laparoscopy combined their experience to develop a specific technique of nonincisional radical prostatectomy for localized prostate cancer. Patients presented with clinical stages T1b to T2 prostate cancer and tumor size was approximately 18 to 130 gm. Operations were performed by 1 senior surgeon and 1 assistant, with the help of a voice controlled robot and with the patient under general anesthesia. The 2, 10 mm. ports and 3, 5 mm. ports were placed in the umbilicus and iliac fossa. The laparoscopic procedure was performed transperitoneally, combining anterograde and retrograde approaches in 7 standardized steps. Urethrovesical anastomosis was performed with 3-zero interrupted sutures tied intracorporeally. Technical details were compiled, summarized and illustrated with schematic views.
Operating time was approximately 3 hours for the last 120 cases. Estimated average blood loss was 250 ml. with a transfusion rate of less than 1%. The conversion rate was 0%. Postoperative pain was minimal and analgesics were generally not required by postoperative day 2. The accuracy of dissection and sutures allowed patients to be discharged home without urethral catheterization starting on postoperative day 3.
Laparoscopic radical prostatectomy is now not only feasible, but more importantly reproducible. Each step has been checked and validated, and the procedure is standardized and has definitively replaced the retropubic approach in our practice.
基于1998年1月至1999年12月间连续260例手术的经验，腹腔镜根治性前列腺切除术已成为我院的标准术式。鉴于其良好的短期疗效，我们在此描述标准化的腹腔镜根治性前列腺切除术技术。
两名接受过开放性耻骨后根治性前列腺切除术和腹腔镜手术培训的泌尿外科医生结合他们的经验，开发了一种针对局限性前列腺癌的非切开根治性前列腺切除术的特定技术。患者表现为临床分期为T1b至T2期的前列腺癌，肿瘤大小约为18至130克。手术由1名资深外科医生和1名助手进行，借助语音控制机器人，患者在全身麻醉下进行。在脐部和髂窝放置2个10毫米端口和3个5毫米端口。腹腔镜手术经腹腔进行，通过7个标准化步骤结合顺行和逆行方法。尿道膀胱吻合采用3-0间断缝线在体内打结。技术细节进行了整理、总结并用示意图说明。
最近120例手术的手术时间约为3小时。估计平均失血量为250毫升，输血率低于1%。转化率为0%。术后疼痛轻微，术后第2天一般不需要使用镇痛药。解剖和缝合的准确性使患者术后第3天即可在不插导尿管的情况下出院回家。
腹腔镜根治性前列腺切除术现在不仅可行，更重要的是可重复。每个步骤都经过检查和验证，该手术已标准化，并在我们的实践中明确取代了耻骨后手术方法。
