Bhandari Mahendra, Menon Mani
Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Blvd., Detroit, MI 48202, USA.
Arch Esp Urol. 2007 May;60(4):397-407. doi: 10.4321/s0004-06142007000400010.
To describe a technique of Robot Assisted Radical Prostatectomy (RAP) for localized carcinoma of the prostate, the Vattikuti Institute Prostatectomy (VIP) and an innovative incremental nerve preservation technique, the Veil of Aphrodite. We also report complications, oncological and functional outcomes in a cohort of the patient operated during 2001-2006.
2,652 patients with localiced carcinoma of prostate underwent VIP at our centre between 2001-2006. Our current technique involves: early division of the bladder neck, preservation of the lateral pelvic fascia and control of the dorsal vein complex after apical dissection of the prostate. Oncological, functional and follow-up information was obtained through "ROBOSURG" data base, which is managed by an independent group not involved in the patient care. VIP, as it has evolved in our hands over a period of 5 years, has given excellent outcomes in terms of cancer control, continence and erectile function. Our modifications of the surgical technique had a singular focus on consistent improvement of the so called "Trifecta", taking radical retropubic prostatectomy (RRP) published data as a reference standard. We present our current technique of VIP with preservation of the lateral prostatic fascia ("Veil of Aphrodite").
In this report we include 2077 patients with follow-up ranging from 4 weeks to 260 weeks (median 68 weeks). We have a low incidence (1.5%) of perioperative complications. 97.6% of our patients had a hospital stay of less than 48 hours. There were 5.8% unscheduled postoperative visits. With the PSA cut-off limit of 0.4 ng/ml, the overall biochemical recurrence rate was 3.9%. Median duration of incontinence was 4 weeks; 0.8% patients had total incontinence at 12 months. The intercourse rate was 93% in men with no pre-operative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function.
Vattikuti Institute Prostatectomy offers excellent patient recovery with significant reduction in first 30 days morbidity and provides excellent oncological and functional outcomes. The preservation of the "Veil of Aphrodite" helps in postoperative return of erectile function in patients with normal preoperative erectile function.
描述一种用于前列腺局限性癌的机器人辅助根治性前列腺切除术（RAP）技术、瓦提库蒂研究所前列腺切除术（VIP）以及一种创新的渐进性神经保留技术——阿佛洛狄忒之幕。我们还报告了2001年至2006年期间接受手术的一组患者的并发症、肿瘤学和功能结果。
2001年至2006年期间，2652例前列腺局限性癌患者在我们中心接受了VIP手术。我们目前的技术包括：早期切断膀胱颈、保留盆腔侧筋膜以及在前列腺尖部解剖后控制背静脉复合体。通过“ROBOSURG”数据库获取肿瘤学、功能和随访信息，该数据库由一个不参与患者护理的独立小组管理。VIP在我们手中经过5年的发展，在癌症控制、控尿和勃起功能方面取得了优异的结果。我们对手术技术的改进特别注重持续改善所谓的“三连胜”，以耻骨后根治性前列腺切除术（RRP）发表的数据作为参考标准。我们展示了目前保留前列腺侧筋膜（“阿佛洛狄忒之幕”）的VIP技术。
在本报告中，我们纳入了2077例患者，随访时间为4周至260周（中位时间68周）。我们的围手术期并发症发生率较低（1.5%）。97.6%的患者住院时间少于48小时。术后非计划就诊率为5.8%。以PSA临界值0.4 ng/ml计算，总体生化复发率为3.9%。尿失禁的中位持续时间为4周；0.8%的患者在12个月时完全尿失禁。在接受保留神经手术且术前无勃起功能障碍的男性中，性交率为93%，尽管只有51%恢复到基线功能。
瓦提库蒂研究所前列腺切除术能使患者恢复良好，显著降低前30天的发病率，并提供优异的肿瘤学和功能结果。保留“阿佛洛狄忒之幕”有助于术前勃起功能正常的患者术后勃起功能恢复。
