Kaouk Jihad H, Desai Mihir M, Abreu Sidney C, Papay Francis, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute A-100, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
J Urol. 2003 Sep;170(3):909-12. doi: 10.1097/01.ju.0000073208.18059.62.
Sural nerve grafting has been done in select patients undergoing radical prostatectomy with unilateral or bilateral wide excision of the neurovascular bundle in an effort to preserve potency. We describe a novel technique of laparoscopic sural nerve grafting after radical prostatectomy using the da Vinci (Intuitive Surgical, Mountain View, California) robot.
The procedure was performed successfully in 3 potent men 48, 49 and 59 years old, respectively. In patient 1 the entire procedure was performed robotically using a 6 port transperitoneal approach. In patients 2 and 3 the robot was used only for sural nerve grafting and urethrovesical anastomosis, while radical prostatectomy was performed by conventional laparoscopy. After the completion of radical prostatectomy with deliberate wide resection of the 2 neurovascular bundles in patients 1 and 3, and unilateral excision of the left neurovascular bundle in patient 2 a plastic surgery team harvested 10 to 15 cm of sural nerve from the left calf. Sural nerve grafts were interposed robotically by placing 4 to 6 interrupted perineural stitches of 6 or 7-zero polypropylene sutures.
Mean operative time was 6.5 hours, mean blood loss was 216 cc and mean hospital stay was 2.3 days. Surgical margins were focally positive at the apex in the patients 1 and 3. During a followup of 7, 5 and 1 months patient 1 reported penile engorgement with sildenafil not sufficient for penetration, patient 2 with unilateral nerve preservation was potent without any medication and patient 3 did not achieve any degree of erection, respectively.
The da Vinci remote robotic system technically facilitates sural nerve grafting during laparoscopic radical prostatectomy. Long-term potency data are essential to validate the technical success.
对于接受根治性前列腺切除术并单侧或双侧广泛切除神经血管束的特定患者，已开展腓肠神经移植术以保留性功能。我们描述了一种在根治性前列腺切除术后使用达芬奇（直观外科公司，加利福尼亚州山景城）机器人进行腹腔镜腓肠神经移植的新技术。
该手术分别成功施用于3例性功能正常的男性患者，年龄分别为48岁、49岁和59岁。患者1采用6孔经腹途径全由机器人完成手术。患者2和3中，机器人仅用于腓肠神经移植和尿道膀胱吻合，而根治性前列腺切除术通过传统腹腔镜进行。在患者1和3完成根治性前列腺切除术并有意广泛切除双侧神经血管束，以及患者2单侧切除左侧神经血管束后，整形手术团队从左小腿获取10至15厘米的腓肠神经。通过放置4至6针6-0或7-0聚丙烯缝线间断缝合神经外膜，以机器人方式植入腓肠神经移植物。
平均手术时间为6.5小时，平均失血量为216毫升，平均住院时间为2.3天。患者1和3的手术切缘在尖部有局灶性阳性。在7个月、5个月和1个月的随访中，患者1报告服用西地那非后阴茎充血，但不足以进行性交；患者2保留单侧神经，未用药时性功能正常；患者3未达到任何程度的勃起。
达芬奇远程机器人系统在技术上便于在腹腔镜根治性前列腺切除术中进行腓肠神经移植。长期性功能数据对于验证技术成功至关重要。
