Schellhammer Paul F, Diaz Jose I, Fabrizio Michael D, Davis John W, Given Robert W, Main Brian, Chaganty N Rao, Hussein Rania, McKenzie Rick
Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia, USA.
J Urol. 2007 Oct;178(4 Pt 1):1301-5. doi: 10.1016/j.juro.2007.05.164. Epub 2007 Aug 14.
The introduction of new surgical approaches to radical prostatectomy requires methodologies that permit valid comparison that are more expedient than long-term outcomes of biochemical local and distant failure and survival. We used a computer modeling program to assess the percent of extracapsular tissue coverage of prostate glands removed by the open retropubic and laparoscopic approaches.
Specimens were available for 15 and 17 patients who underwent open and laparoscopic radical prostatectomy, respectively. Serial whole mount sections were taken at 5 mm intervals. A genitourinary pathologist drew the contours of the prostate capsule on each tissue section. The whole mount was scanned to produce digital images. A software program was used to create a file with capsule information and a file with extraprostatic fibroadipose tissue information. Two separate point cloud files were generated to represent the capsule and extraprostatic models, and software algorithms were used to generate differences in the point clouds to quantify the extent of extracapsular tissue coverage.
When separated into sides dissected by a nerve or nonnerve sparing technique, the overall percent of gland surface coverage by extracapsular fibroadipose tissue was statistically greater with laparoscopic dissection than with the open approach. When a segmental analysis of gland coverage was evaluated, a statistically greater percent of fibroadipose coverage was associated with laparoscopic dissection in the apical and inferolateral segments with nonnerve sparing, and in the apical segment with nerve sparing.
This small radical prostatectomy series, analyzed by computer reconstruction as described, provides information suggesting that overall extracapsular tissue coverage is at least equal if not superior using the laparoscopic vs the open approach. This was specifically the case in areas of inferolateral and apical dissection with nonnerve sparing procedures and in areas of the apical dissection with nerve sparing procedures.
根治性前列腺切除术新手术方法的引入需要能够进行有效比较的方法，这些方法要比生化局部和远处失败及生存的长期结果更便捷。我们使用计算机建模程序来评估经耻骨后开放手术和腹腔镜手术切除的前列腺腺体的包膜外组织覆盖百分比。
分别有15例和17例接受开放和腹腔镜根治性前列腺切除术的患者的标本可供使用。以5毫米的间隔进行连续的全层切片。一名泌尿生殖病理学家在每个组织切片上绘制前列腺包膜的轮廓。对全层切片进行扫描以生成数字图像。使用一个软件程序创建一个包含包膜信息的文件和一个包含前列腺外纤维脂肪组织信息的文件。生成两个单独的点云文件来表示包膜和前列腺外模型，并使用软件算法生成点云差异以量化包膜外组织覆盖范围。
当按保留神经或不保留神经技术所解剖的侧别分开时，腹腔镜解剖的包膜外纤维脂肪组织对腺体表面的总体覆盖百分比在统计学上高于开放手术。当评估腺体覆盖的节段分析时，在不保留神经的情况下，腹腔镜解剖在尖部和下外侧节段以及保留神经的情况下在尖部节段，包膜外纤维脂肪组织的覆盖百分比在统计学上更高。
按照所述通过计算机重建分析的这个小样本根治性前列腺切除术系列提供的信息表明，使用腹腔镜手术与开放手术相比，总体包膜外组织覆盖至少相当，如果不是更优的话。在不保留神经的下外侧和尖部解剖区域以及保留神经的尖部解剖区域尤其如此。
