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 Laparoendosc Adv Surg Tech A. 2009 Feb;19(1):23-7. doi: 10.1089/lap.2008.0099.
Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. The majority of these series have reported techniques and outcomes in a predominantly male patient population. The application of such novel techniques to female cystectomy and anterior exenterative procedures has not been well documented and described. In this paper, we report our initial experience with robotic anterior pelvic exenteration in the female with bladder cancer evaluating perioperative and pathologic outcomes of this novel procedure and comparing the outcomes to those observed in their male counterparts.
Fifty patients underwent a robotic radical cystectomy and extracorporeal diversion for clinically localized bladder cancer: 40 male patients (robotic radical cystoprostatetctomy) and 10 women (robotic anterior pelvic exenteration). Outcome measures evaluated in this series included operative variables, hospital recovery, pathologic outcomes, and complication rate.
Mean age of female patients was 68.4 years and of male patients was 62.8. Mean operating room time was 4.6 hours, and mean surgical blood loss was 215 mL. On surgical pathology, 5 patients were <=pT2, 3 patients pT3, and 2 patients N+. In no case was there a positive surgical margin, though in 1 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, time to bowel movement 2.4 days, and time to discharge 4.9 days. These outcomes were comparable to the male patients, particularly the 20 male patients undergoing robotic radical cystoprostatectomy during the same time period.
In our experience, the robotic anterior exenteration has been readily adapted to the surgical treatment of bladder cancer with similar outcomes to those observed in male patients undergoing a robotic radical cystoprostatectomy. The approach appears to achieve the clinical and oncologic goals of radical cystectomy in both the female and male patient.
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。这些系列中的大多数报道了主要为男性患者群体的技术和结果。此类新技术在女性膀胱切除术和前盆腔脏器清除术中的应用尚未得到充分记录和描述。在本文中，我们报告了我们在患有膀胱癌的女性患者中进行机器人辅助前盆腔脏器清除术的初步经验，评估了这一新技术的围手术期和病理结果，并将结果与男性患者的观察结果进行比较。
50例患者接受了机器人根治性膀胱切除术及体外改道治疗临床局限性膀胱癌：40例男性患者（机器人根治性膀胱前列腺切除术）和10例女性患者（机器人前盆腔脏器清除术）。本系列评估的结果指标包括手术变量、住院恢复情况、病理结果和并发症发生率。
女性患者的平均年龄为68.4岁，男性患者为62.8岁。平均手术时间为4.6小时，平均手术失血量为215毫升。手术病理显示，5例患者≤pT2，3例患者pT3，2例患者N+。无一例手术切缘阳性，不过有1例意外进入膀胱。平均切除淋巴结数为19个（范围为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4.9天。这些结果与男性患者相当，特别是同期接受机器人根治性膀胱前列腺切除术的20例男性患者。
根据我们的经验，机器人前盆腔脏器清除术已很容易适用于膀胱癌的手术治疗，其结果与接受机器人根治性膀胱前列腺切除术的男性患者相似。该方法似乎在女性和男性患者中均实现了根治性膀胱切除术的临床和肿瘤学目标。
