Hakimi Ari Abraham, Feder Marc, Ghavamian Reza
Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Urol J. 2007 Summer;4(3):130-7.
While radical retropubic prostatectomy has been the gold standard surgical approach, the explosion of minimally invasive methods has led to the search for less invasive treatment options. We offer an overview of the evolution of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) in terms of the landmark publications and recent head-to-head comparisons, and we review our own experience.
A Medline search was performed using the keywords prostate cancer, prostatectomy, laparoscopic, and robotic. All pertinent articles concerning localized prostate cancer were reviewed. The Montefiore experience consisted of a retrospective review of a prospectively maintained confidential database.
Several laparoscopic and robotic series were identified including review articles of each modality as well as studies directly comparing the two. Both LRP and RALP compare very favorably with conventional open surgery in terms of safety and oncologic efficacy. Both minimally invasive approaches offer decreased blood loss, transfusion rate, and length of hospital stay when contrasted with open surgery. When compared directly, LRP and RALP offer similar surgical, oncologic, and functional outcomes. However, RALP likely requires a shorter learning curve.
The use of minimally invasive techniques has revolutionized the surgical treatment of prostate cancer. Pure LRP has been shown to be feasible and reproducible. However, it has a steep learning curve and is difficult to learn. In contrast, RALP is easier to learn and is now the surgical treatment of choice in most centers of excellence in the United States. The superior optics with respect to visualization and magnification translates into a procedure that is equivalent, if not superior, with respect to perioperative parameters, oncologic outcomes, and functional outcomes to its open counterpart.
虽然耻骨后根治性前列腺切除术一直是金标准手术方式，但微创方法的激增促使人们寻求侵入性更小的治疗选择。我们根据具有里程碑意义的出版物和近期的直接对比研究，概述了腹腔镜根治性前列腺切除术（LRP）和机器人辅助腹腔镜前列腺切除术（RALP）的发展历程，并回顾了我们自己的经验。
使用关键词前列腺癌、前列腺切除术、腹腔镜和机器人进行了Medline检索。对所有关于局限性前列腺癌的相关文章进行了综述。蒙特菲奥里医疗中心的经验包括对一个前瞻性维护的保密数据库进行回顾性分析。
确定了几个腹腔镜和机器人手术系列，包括每种手术方式的综述文章以及直接比较两者的研究。LRP和RALP在安全性和肿瘤学疗效方面与传统开放手术相比都非常有利。与开放手术相比，这两种微创方法都能减少失血量、输血率和住院时间。直接比较时，LRP和RALP的手术、肿瘤学和功能结果相似。然而，RALP可能需要较短的学习曲线。
微创技术的应用彻底改变了前列腺癌的外科治疗。单纯LRP已被证明是可行且可重复的。然而，它有陡峭的学习曲线且难以掌握。相比之下，RALP更容易学习，现在是美国大多数卓越中心的首选手术治疗方法。在可视化和放大方面的优越光学性能转化为一种在围手术期参数、肿瘤学结果和功能结果方面与开放手术相当（如果不是更优）的手术。
