Patel Vipul R, Thaly Rahul, Shah Ketul
Center for Robotic and Computer Assisted Surgery, Division of Urology, Ohio State University, Columbus, OH 43210-1228, USA.
BJU Int. 2007 May;99(5):1109-12. doi: 10.1111/j.1464-410X.2007.06762.x.
To report the outcomes of 500 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer.
In all, 500 patients had RALP over a 30-month period. A transperitoneal six-port approach was used in each case, with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality-of-life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency.
The mean (range) duration of RALP was 130 (51-330) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 10-300 mL; 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 6.9 (5-21) days. The positive margin rate was 9.4% for all patients; i.e. 2.5% for T2 tumours, 23% for T3a and 53% for T4. The overall biochemical recurrence free (PSA level<0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 3 and 6 months in 89% and 95% of patients, respectively. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy.
RALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes.
报告500例机器人辅助腹腔镜根治性前列腺切除术（RALP）的结果，这是一种治疗前列腺癌的微创替代方法。
在30个月期间，共有500例患者接受了RALP手术。每例均采用经腹六孔入路，使用达芬奇机器人手术系统（美国加利福尼亚州森尼韦尔市直观外科公司）。前瞻性数据收集包括生活质量问卷、基本人口统计学信息（身高、体重和体重指数）、前列腺特异性抗原（PSA）水平、临床分期和 Gleason分级。RALP术中评估的变量包括手术时间、估计失血量（EBL）和并发症，术后评估的变量包括住院时间、导尿管留置时间、病理、PSA水平、控尿恢复情况和性功能恢复情况。
RALP的平均（范围）手术时间为130（51 - 330）分钟；所有手术均成功，无术中输血或死亡情况。平均EBL为10 - 300毫升；97%的患者在RALP术后第一天出院，平均血细胞比容为36%。平均导尿管留置时间为6.9（5 - 21）天。所有患者的切缘阳性率为9.4%；即T2期肿瘤为2.5%，T3a期为23%，T4期为53%。在平均9.7个月的随访中，总体无生化复发（PSA水平<0.1 ng/mL）生存率为95%。分别有89%和95%的患者在3个月和6个月时实现完全控尿。1年后，78%的患者性功能恢复（无论是否使用口服药物），15%的患者仍无法维持性交所需的勃起功能，另有7%的患者仍需要注射治疗。
RALP是一种治疗前列腺癌的安全、可行且微创的替代方法。我们对该手术的初步经验显示了良好的短期效果。
