Desai Mihir M, Aron Monish, Berger Andre, Canes David, Stein Robert, Haber Georges-Pascal, Kamoi Kazumi, Crouzet Sebastien, Sotelo Rene, Gill Inderbir S
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
BJU Int. 2008 Dec;102(11):1666-9. doi: 10.1111/j.1464-410X.2008.08004.x. Epub 2008 Sep 18.
To report the technical feasibility of performing transvesical robotic radical prostatectomy (TRRP) in a cadaver.
TRRP was performed in two fresh male cadavers (prostate volume 46 and 30 mL). In the first procedure we used four laparoscopic transvesical trocars and in the second a single-port device was placed percutaneously into the bladder. Pneumovesicum was established in both cases and the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the TRRP. All steps of the procedure, including dissection of the seminal vesicles and vas deferens, ligation of prostatic pedicles, release of neurovascular bundles, apical dissection, urethral transection, and urethro-vesical anastomosis, were done transvesically and robotically. Real time transrectal ultrasonography monitoring was used in the first cadaver.
Both procedures were technically successful transvesically with no need for additional ports or conversion to standard laparoscopy. The operative duration for the multi-port procedure was 3 h and for the single-port procedure was 4.2 h. Clashing of the da Vinci arms was the primary technical difficulty with the single-port procedure, but did not occur in the multi-port procedure.
TRRP under pneumovesicum is technically feasible using multiple-port or a single-port approach in the cadaver. The clinical application of this novel approach is imminent. Further refinement of technique and instruments might lead to an increasing role of percutaneous intraluminal surgery in various surgical disciplines.
报告在尸体上进行经膀胱机器人根治性前列腺切除术（TRRP）的技术可行性。
在两具新鲜男性尸体（前列腺体积分别为46和30 mL）上进行TRRP。在第一次手术中，我们使用了四个腹腔镜经膀胱套管针，第二次手术中，一个单孔装置经皮置入膀胱。两例均建立了气膀胱，使用达芬奇-S机器人系统（美国加利福尼亚州森尼韦尔市直观外科公司）进行TRRP。手术的所有步骤，包括精囊和输精管的解剖、前列腺蒂的结扎、神经血管束的游离、尖部解剖、尿道横断以及尿道膀胱吻合，均经膀胱通过机器人完成。第一具尸体使用了实时经直肠超声监测。
两例手术经膀胱技术均成功，无需额外切口或转为标准腹腔镜手术。多端口手术的手术时间为3小时，单端口手术为4.2小时。单端口手术的主要技术难点是达芬奇机器人手臂碰撞，多端口手术未出现此情况。
在尸体上使用多端口或单端口方法经气膀胱进行TRRP技术上是可行的。这种新方法的临床应用即将实现。技术和器械的进一步改进可能会使经皮腔内手术在各个外科学科中发挥越来越重要的作用。
