Murphy Declan G, Challacombe Ben J, Elhage Oussama, O'Brien Tim S, Rimington Peter, Khan Mohammad Shamim, Dasgupta Prokar
Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Eur Urol. 2008 Sep;54(3):570-80. doi: 10.1016/j.eururo.2008.04.011. Epub 2008 Apr 11.
The use of robotic technology for laparoscopic prostatectomy is now well established. The same cannot yet be said of robotic-assisted laparoscopic radical cystectomy (RARC), which is performed in just a few centres worldwide.
We present our technique and experience of this procedure using the da Vinci surgical system.
DESIGN, SETTING, AND PARTICIPANTS: From 2004 to 2007, 23 patients underwent RARC and urinary diversion at our institution.
We report the development of our technique for RARC, which involves posterior dissection, lateral pedicle control, anterior dissection, and lymphadenectomy prior to either ileal conduit urinary diversion or Studer pouch reconstruction performed extracorporeally.
Demographic and perioperative data were recorded prospectively. Oncologic and functional outcomes were assessed at 3- to 6-mo intervals.
To date, 23 patients have undergone this procedure at our institution. Of those, 19 had ileal loop urinary diversion and 4 were suitable for Studer pouch reconstruction. Mean total operative time plus or minus (+/-) standard deviation (SD) was 397+/-83.8min. Mean blood loss +/-SD was 278+/-229ml with one patient requiring a blood transfusion. Surgical margins were clear in all patients with a median +/-SD of 16+/-8.9 lymph nodes retrieved. The complication rate was 26%. At a mean follow-up +/-SD of 17+/-13 (range 4-40) mo, one patient had died of metastatic disease and one other is alive with metastases. The remaining 21 patients are alive without recurrence.
RARC remains a procedure in evolution in the small number of centres carrying out this type of surgery. Our initial experience confirms that it is feasible with acceptable morbidity and good short-term oncologic results.
机器人技术用于腹腔镜前列腺切除术现已得到广泛认可。但机器人辅助腹腔镜根治性膀胱切除术（RARC）的情况却并非如此，全球仅有少数几个中心开展该手术。
我们介绍使用达芬奇手术系统进行该手术的技术和经验。
设计、场所和参与者：2004年至2007年，我们机构有23例患者接受了RARC及尿流改道术。
我们报告了RARC技术的发展情况，该技术包括在进行体外回肠导管尿流改道术或Studer膀胱重建术前进行后入路解剖、侧蒂控制、前入路解剖和淋巴结清扫。
前瞻性记录人口统计学和围手术期数据。每隔3至6个月评估肿瘤学和功能结果。
迄今为止，我们机构有23例患者接受了该手术。其中，19例行回肠袢尿流改道术，4例适合Studer膀胱重建术。平均总手术时间±标准差（SD）为397±83.8分钟。平均失血量±SD为278±229毫升，1例患者需要输血。所有患者手术切缘均清晰，中位±SD为16±8.9枚淋巴结被切除。并发症发生率为26%。平均随访时间±SD为17±13（范围4 - 40）个月，1例患者死于转移性疾病，另1例患者有转移灶存活。其余21例患者存活且无复发。
在开展这类手术的少数中心，RARC仍是一种仍在不断发展的手术。我们的初步经验证实，该手术是可行的，发病率可接受，短期肿瘤学结果良好。
