Pruthi Raj S, Stefaniak Heather, Hubbard J Slade, Wallen Eric M
Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
J Endourol. 2008 Oct;22(10):2397-402; discussion 2402. doi: 10.1089/end.2008.0108.
Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. Herein, we describe our approach and initial experience with robotic-assisted laparoscopic anterior pelvic exenteration in the female patient with bladder cancer.
We describe the technique of robotic-assisted laparoscopic anterior pelvic exenteration. The classic da Vinci or the da Vinci S robotic platform is utilized for the procedure. In our experience, 12 women underwent robotic-assisted laparoscopic anterior pelvic exenteration and extracorporeal urinary diversion for clinically localized bladder cancer.
Mean age was 67.9 years (range 61-79 years). Nine patients underwent ileal conduit diversion and three patients underwent an orthotopic neobladder. In all cases, the urinary diversion was performed extracorporeally. Mean operating room time was 4.6 h; mean surgical blood loss was 221 mL. On surgical pathology, seven patients were =pT2, three patients were pT3, and two patients were N+. In no case was there positive surgical margins, and in one case there was inadvertent entry into the bladder. Mean number of lymph nodes removed was 19 (range 12-34). Mean time to flatus was 1.9 days and to bowel movement 2.4 days, and time to discharge 4.8 days. Six patients were discharged on postoperative day 4, four patients on postoperative day 5, one on postoperative day 6, and one on postoperative day 8. There were two postoperative complications (17%) in two patients.
Our initial experience with robotic-assisted laparoscopic anterior pelvic exenteration appears to be favorable with acceptable operative, pathologic, and short-term clinical outcomes. Certainly, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical and oncologic option.
近期已有关于机器人辅助腹腔镜根治性膀胱切除术的小型病例系列报道。在此，我们描述我们对患有膀胱癌的女性患者进行机器人辅助腹腔镜前盆腔脏器清除术的方法及初步经验。
我们描述机器人辅助腹腔镜前盆腔脏器清除术的技术。该手术采用经典的达芬奇或达芬奇S机器人平台。根据我们的经验，12名女性患者因临床局限性膀胱癌接受了机器人辅助腹腔镜前盆腔脏器清除术及体外尿液改道。
平均年龄为67.9岁（范围61 - 79岁）。9名患者接受了回肠导管改道，3名患者接受了原位新膀胱术。所有病例均在体外进行尿液改道。平均手术时间为4.6小时；平均手术失血量为221毫升。手术病理显示，7名患者为≤pT2，3名患者为pT3，2名患者为N+。无一例手术切缘阳性，有1例意外进入膀胱。平均切除淋巴结数为19个（范围12 - 34个）。平均排气时间为1.9天，排便时间为2.4天，出院时间为4.8天。6名患者在术后第4天出院，4名患者在术后第5天出院，1名患者在术后第6天出院，1名患者在术后第8天出院。2名患者出现2例术后并发症（17%）。
我们对机器人辅助腹腔镜前盆腔脏器清除术的初步经验似乎良好，手术、病理及短期临床结果均可接受。当然，需要更多的经验来充分评估和验证该手术作为一种合适的外科和肿瘤学选择。
