Durand X, Vaessen C, Bitker M-O, Richard F
Service d'urologie et transplantation rénale, GHU, Pitié-Salpêtrière, 47-83, boulevard-de-l'Hôpital, 75651 Paris cedex 13, France.
Prog Urol. 2008 Jan;18(1):60-7. doi: 10.1016/j.purol.2007.10.013. Epub 2008 Mar 4.
Compare three surgical approach procedures of total prostatectomy (retropubic, transperitoneal laparoscopic and robot-assisted laparoscopic), about technical, oncological and functional results.
Eighty-six patients had a total prostatectomy for localized cancer, in a unique center, performed by two expert surgeons, on a 16-months-period. Twenty nine had a retropubic, 23 a transperitoneal laparoscopic and 34 a robot-assisted (Da Vinci) surgical approach. Retrospectively, operative time, blood loss, per- and postoperative complications, duration of catheterization, length of hospital stay, in each group had been compared. The positive margin rates, the PSA levels at one and six months postoperative had been compared. The continence has also been evaluated at six months.
The three groups are comparable even if the median age is significatively lower in the retropubic group (p=0.018). Duration of catheter (p<2.2 x 10(-16)), blood loss (p<3.12 x 10(-5)) and operative times support significatively the laparscopic approaches, clearer the conventional than the robot-assisted one. No significative difference has been shown about positive margin rates, even if it's higher in the robot-assisted group (p=0.37). Finally, the continence rate is quite higher in the laparoscopic groups without statistic significativity (76 % retropubic versus 96.8 % laparoscopic and 85.3 % robot-assisted).
The conventional laparoscopic and robot-assisted approaches seem to present technical advantages. Nevertheless, pathologic results are shader: the positive margin rate in the robot-assisted group is higher, in particular regarding to pT2. These results are concordant with the available datas of the literature.
比较全前列腺切除术的三种手术入路方法（耻骨后、经腹腹腔镜和机器人辅助腹腔镜）在技术、肿瘤学和功能方面的结果。
在一个中心，由两位专家外科医生在16个月期间为86例局限性癌症患者实施了全前列腺切除术。29例采用耻骨后入路，23例采用经腹腹腔镜入路，34例采用机器人辅助（达芬奇）手术入路。回顾性比较了每组的手术时间、失血量、围手术期和术后并发症、导尿持续时间、住院时间。比较了切缘阳性率、术后1个月和6个月时的前列腺特异抗原（PSA）水平。还在术后6个月评估了控尿情况。
三组具有可比性，尽管耻骨后组的中位年龄显著更低（p = 0.018）。导尿持续时间（p < 2.2×10⁻¹⁶）、失血量（p < 3.12×10⁻⁵）和手术时间显著支持腹腔镜入路，传统腹腔镜入路比机器人辅助入路更明显。切缘阳性率方面未显示出显著差异，尽管机器人辅助组的切缘阳性率更高（p = 0.37）。最后，腹腔镜组的控尿率相当高，但无统计学意义（耻骨后组为76%，腹腔镜组为96.8%，机器人辅助组为85.3%）。
传统腹腔镜和机器人辅助入路似乎具有技术优势。然而，病理结果有所不同：机器人辅助组的切缘阳性率更高，尤其是对于pT2期。这些结果与文献中的现有数据一致。
