Chien Gary W, Mikhail Albert A, Orvieto Marcelo A, Zagaja Gregory P, Sokoloff Mitchell H, Brendler Charles B, Shalhav Arieh L
Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
Urology. 2005 Aug;66(2):419-23. doi: 10.1016/j.urology.2005.03.015.
We present our technique for clipless antegrade neurovascular bundle preservation during robotic laparoscopic radical prostatectomy, along with short-term follow-up of our patients' sexual function.
Using the da Vinci three-arm robotic system, we performed robotic laparoscopic radical prostatectomy using a transperitoneal approach in an antegrade fashion. After division of the bladder neck, the posterior plane of the prostate was developed distally toward the apex of the prostate in the midline. This plane was then developed completely, releasing the vascular pedicles and neurovascular bundles in a medial to lateral direction, with occasional use of bipolar cautery and without the use of clips or monopolar cautery. Patients with a minimal follow-up of 3 months who did not require open conversion were included in this study. A total of 56 patients met these inclusion criteria between February 2003 and May 2004, with a mean follow-up of 6 months. Patients were given the validated Rand Medical Outcomes Study 36-Item Health Survey, version 2, with the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. The overall score for both unilateral and bilateral nerve-sparing groups was 35.0, 39.7, 49.4, and 49.6 at 1, 3, 6, and 12 months postoperatively, respectively. These coincided with a return to baseline potency rate of 47%, 54%, 66%, and 69% at 1, 3, 6, and 12 months, respectively.
Antegrade dissection of the neurovascular bundle, avoiding the use of clips or monopolar cautery during robotic laparoscopic radical prostatectomy, may result in early return of sexual function and overall outcome similar to that after radical retropubic prostatectomy.
我们介绍了在机器人腹腔镜根治性前列腺切除术中保留无夹顺行神经血管束的技术，以及对患者性功能的短期随访情况。
使用达芬奇三臂机器人系统，我们采用经腹途径以顺行方式进行机器人腹腔镜根治性前列腺切除术。在离断膀胱颈后，于中线向前列腺尖部向远侧游离前列腺后平面。然后将该平面完全游离，从内侧向外侧释放血管蒂和神经血管束，偶尔使用双极电凝，不使用夹子或单极电凝。本研究纳入了随访至少3个月且无需转为开放手术的患者。2003年2月至2004年5月期间共有56例患者符合这些纳入标准，平均随访6个月。术前及术后1、3、6和12个月，患者接受了经过验证的兰德医学结果研究36项健康调查第2版以及加利福尼亚大学洛杉矶分校前列腺癌指数评估。单侧和双侧保留神经组术后1、3、6和12个月的总体评分分别为35.0、39.7、49.4和49.6。这些评分分别对应术后1、3、6和12个月恢复至基线勃起功能的比例为47%、54%、66%和69%。
在机器人腹腔镜根治性前列腺切除术中，顺行游离神经血管束，避免使用夹子或单极电凝，可能会使性功能早期恢复，总体结果与耻骨后根治性前列腺切除术后相似。
