Stolzenburg Jens-Uwe, Do Minh, Pfeiffer Heidemarie, König Fritjoff, Aedtner Bernd, Dorschner Wolfgang
University of Leipzig, Department of Urology, Germany.
World J Urol. 2002 May;20(1):48-55. doi: 10.1007/s00345-002-0265-4.
Using the experiences of the extraperitoneal (endoscopic pelvic lymphadenectomy and inguinal hernia repair) and the transperitoneal approach (laparoscopic radical prostatectomy), we developed a totally extraperitoneal approach to endoscopic radical prostatectomy. In view of the favourable short-term outcome, we describe the technique of totally extraperitoneal endoscopic radical prostatectomy (EERPE) as a now standardised procedure. After creating the preperitoneal space by balloon dissection, five trocars were placed in the hypogastrium, allowing immediate access to the space of Retzius. The surgical technique of EERPE replicates the steps of the classical retropubic descending radical prostatectomy with slight modifications. The procedure starts with exposing the Retzius space and pelvic lymph node dissection. After that, the endopelvic fascia and the puboprostatic ligaments are incised, followed by ligating the Santorini plexus. The actual prostate dissection is similar to the open descending approach: bladder neck dissection, freeing of the seminal vesicles, transsectioning of the prostatic vesicles (with or without preserving the neurovascular bundles) and, finally, apical dissection. A water-tight urethrovesical anastomosis is performed with interrupted sutures. There were 20 patients who underwent EERPE. Mean operating time was 170 min with no conversion. No major complications occurred. Only one patient required a blood transfusion. The catheter could be removed on postoperative day 6 (n = 17) or on postoperative day 12 (n = 3). Final pathologic evaluations were 4 stage pT2a, 10 stage pT2b, 5 stage pT3a, and 1 pT3b. Surgical margins were negative in 17 patients. By avoiding entry into the peritoneal cavity, therefore, obviating intra-abdominal complications, such as bowel injury, ileus, or intestinal adhesions, the extraperitoneal endoscopic access provides a safe and minimally invasive approach to the prostate, combining the advantages of minimally invasive laparoscopy and retropubic open prostatectomy.
利用腹膜外途径（内镜下盆腔淋巴结清扫术和腹股沟疝修补术）和经腹途径（腹腔镜前列腺癌根治术）的经验，我们开发了一种完全腹膜外途径的内镜前列腺癌根治术。鉴于良好的短期效果，我们将完全腹膜内镜前列腺癌根治术（EERPE）技术描述为一种现已标准化的手术。通过球囊分离创建腹膜前间隙后，在耻骨上区放置5个套管针，可立即进入Retzius间隙。EERPE的手术技术复制了经典耻骨后下行前列腺癌根治术的步骤，但有轻微修改。手术从暴露Retzius间隙和盆腔淋巴结清扫开始。之后，切开盆腔内筋膜和耻骨前列腺韧带，接着结扎Santorini丛。实际的前列腺分离与开放下行途径相似：膀胱颈分离、精囊游离、前列腺囊横断（保留或不保留神经血管束），最后是尖部分离。用间断缝合进行水密性尿道膀胱吻合。有20例患者接受了EERPE。平均手术时间为170分钟，无中转。未发生重大并发症。只有1例患者需要输血。导尿管可在术后第6天（n = 17）或术后第12天（n = 3）拔除。最终病理评估为4例pT2a期、10例pT2b期、5例pT3a期和1例pT3b期。17例患者手术切缘阴性。因此，通过避免进入腹腔，消除诸如肠损伤、肠梗阻或肠粘连等腹腔内并发症，腹膜外内镜入路为前列腺提供了一种安全且微创的方法，结合了微创腹腔镜和耻骨后开放前列腺切除术的优点。
