Sim Hong Gee, Yip Sidney K H, Lau Weber K O, Tan James K, Cheng Christopher W S
Department of Urology, Singapore General Hospital, Singapore.
Asian J Surg. 2004 Oct;27(4):321-5. doi: 10.1016/S1015-9584(09)60060-9.
We assessed the feasibility of a robot-assisted laparoscopic radical prostatectomy (rLRP) programme through a review of our early experience.
Seventeen patients underwent rLRP between 1 February 2003 and 31 December 2003 at Singapore General Hospital. All patients had histologically confirmed adenocarcinoma on prostate biopsy and a negative bone scan. The Da Vinci robot was employed. The Montsouris technique was used for our first eight patients, and the Vattikuti Institute Prostatectomy technique was used for all subsequent patients. We studied perioperative parameters and early surgical outcome prospectively.
The mean age at diagnosis was 63.9 +/- 5.6 years. The median Gleason sum was 6 (range, 5-9), and mean pretreatment prostate-specific antigen level was 10.5 +/- 5.4 ng/mL. The mean set-up time was 34 +/- 18 minutes, and mean dissection time was 247 +/- 43 minutes. Perioperative blood loss averaged 494 +/- 330 mL, and three patients required blood transfusion. Normal diet was resumed after 1.7 +/- 0.6 days. The mean duration of bladder catheterization was 9.8 +/- 6.1 days, and mean hospital stay was 2.7 +/- 1.3 days. There was no perioperative mortality or major complications, and no conversion to open radical prostatectomy. From Case 9 onwards, there was significant reduction in operating time (284 vs 215 minutes), blood loss (650 vs 400 mL) and hospital stay (3.8 vs 1.8 days).
rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.
我们通过回顾早期经验来评估机器人辅助腹腔镜根治性前列腺切除术（rLRP）方案的可行性。
2003年2月1日至2003年12月31日期间，17例患者在新加坡总医院接受了rLRP手术。所有患者经前列腺活检组织学确诊为腺癌，且骨扫描阴性。采用达芬奇机器人。前8例患者采用蒙苏里技术，其后所有患者采用瓦蒂库蒂研究所前列腺切除术技术。我们前瞻性地研究围手术期参数和早期手术结果。
诊断时的平均年龄为63.9±5.6岁。Gleason评分中位数为6（范围5 - 9），术前平均前列腺特异性抗原水平为10.5±5.4 ng/mL。平均安装时间为34±18分钟，平均解剖时间为247±43分钟。围手术期平均失血量为494±330 mL，3例患者需要输血。术后1.7±0.6天恢复正常饮食。平均膀胱导尿时间为9.8±6.1天，平均住院时间为2.7±1.3天。无围手术期死亡或重大并发症，无转为开放性根治性前列腺切除术的情况。从第9例病例起，手术时间（284分钟对215分钟）、失血量（650 mL对400 mL）和住院时间（3.8天对1.8天）均显著减少。
在根治性前列腺切除术例数较少的情况下，rLRP是可行的。在前8例病例之后，围手术期参数有显著改善。该技术为盆腔复杂腹腔镜手术带来了更高的精准度和灵活性。
