Levinson Adam W, Su Li-Ming
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Curr Opin Urol. 2007 Mar;17(2):98-103. doi: 10.1097/MOU.0b013e32802b7094.
Laparoscopic radical prostatectomy is now considered the standard of care at many centers for the treatment of localized prostate cancer. As with other surgical approaches, there has been an evolution in surgical techniques. Critical evaluation of the effects of these changes on clinical and pathologic outcomes continues.
The technique of nerve sparing laparoscopic radical prostatectomy should attempt to mimic the techniques and outcomes of open surgery, while maintaining the advantages of reduced blood loss and morbidity, and greater visualization. Long-term functional and oncologic outcomes appear equivalent to open surgery. Surgical approaches based upon recent anatomic studies of the periprostatic neuroanatomy continue to spur both advances and debate. Athermal dissection near the neurovascular bundle, along with high release of the surrounding fascia, may hasten recovery of erectile function. Techniques of sparing or reconstructing the puboprostatic ligaments and support of the bladder are evolving in efforts to improve continence results. Debate over the merits of transperitoneal vs. extraperitoneal approaches to laparoscopic prostatectomy continues.
Nerve sparing laparoscopic radical prostatectomy, although technically challenging, has proven to be an excellent alternative for dedicated centers wishing to provide a minimally invasive surgical option to their patients with localized prostate cancer.
腹腔镜根治性前列腺切除术目前在许多中心被视为治疗局限性前列腺癌的标准治疗方法。与其他手术方式一样，手术技术也在不断发展。对这些变化对临床和病理结果的影响的批判性评估仍在继续。
保留神经的腹腔镜根治性前列腺切除术技术应试图模仿开放手术的技术和结果，同时保持减少失血和发病率以及更好可视化的优势。长期功能和肿瘤学结果似乎与开放手术相当。基于近期前列腺周围神经解剖学研究的手术方法继续推动着进步和争论。在神经血管束附近进行无热解剖，以及高度松解周围筋膜，可能会加速勃起功能的恢复。保留或重建耻骨前列腺韧带以及支撑膀胱的技术正在不断发展，以努力改善控尿结果。关于腹腔镜前列腺切除术经腹腔与腹膜外途径优缺点的争论仍在继续。
保留神经的腹腔镜根治性前列腺切除术虽然在技术上具有挑战性，但已被证明是希望为局限性前列腺癌患者提供微创外科手术选择的专业中心的一种极佳替代方法。
