Kawakita M, Sato M, Oguchi N, Muguruma K, Murota T, Matsuda T
Department of Urology, Kansai Medical University, Moriguchi, Japan.
Nihon Hinyokika Gakkai Zasshi. 2001 May;92(4):506-12. doi: 10.5980/jpnjurol1989.92.506.
In 1998 Guillonneau et al reported feasible and safe technique for laparoscopic radical prostatectomy. Herein we review initial 5 cases with using the Montsouris technique.
Between January and April 2000, 5 patients underwent transperitoneal laparoscopic radical prostatectomy. Clinical stages were T1c in 2, T2a in 1 and T2b in 2 patients. Preoperative PSA levels and Gleason grades in needle biopsies ranged from 7.9 to 39 ng/ml and from 2 to 6, respectively. Under general anesthesia 5 to 6 trocars were introduced and the patient was placed in the exaggerated Trendelenburg position. In 2 patients bilateral obturator lymph nodes were dissected for frozen pathological examination. Antegrade prostatectomy was performed initiating with the transperitoneal dissection of seminal vesicles. A watertight vesicourethral anastomosis was made with 8 to 10 interrupted sutures.
Operating time and blood loss ranged from 505 to 925 minutes and from 100 to 700 gm, respectively. There were no intraoperative complications and one postoperative complication of prolonged urinary leakage, which was spontaneously closed. In other 4 patients Foley catheters were removed on postoperative day 6 to 10.
Laparoscopic radical prostatectomy provides better visualization, inducing meticulous surgical procedures and less blood loss. More sophisticated maneuver would be required in dissection between the prostate and the bladder neck.
1998年吉洛诺等人报道了腹腔镜根治性前列腺切除术的可行且安全的技术。在此，我们回顾使用蒙苏里技术的最初5例病例。
2000年1月至4月期间，5例患者接受了经腹腹腔镜根治性前列腺切除术。临床分期为T1c期2例，T2a期1例，T2b期2例。术前前列腺特异性抗原（PSA）水平和穿刺活检的Gleason分级分别为7.9至39 ng/ml和2至6级。在全身麻醉下插入5至6个套管针，患者置于极度头低脚高位。2例患者行双侧闭孔淋巴结清扫术以进行冷冻病理检查。顺行前列腺切除术从经腹分离精囊开始。用8至10针间断缝合进行水密性膀胱尿道吻合。
手术时间和失血量分别为505至925分钟和100至700克。无术中并发症，术后有1例长期尿漏并发症，该并发症自行闭合。其他4例患者在术后第6至10天拔除导尿管。
腹腔镜根治性前列腺切除术视野更好，手术操作精细，失血量少。在前列腺与膀胱颈之间的分离需要更复杂的操作。
