Vattikuti Urology Institute, Henry Ford Hospital and Henry Ford Health Systems, Detroit, MI 48202, USA.
Eur Urol. 2009 Jul;56(1):89-96. doi: 10.1016/j.eururo.2009.04.032. Epub 2009 Apr 22.
Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients.
To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results.
DESIGN, SETTING, AND PARTICIPANTS: Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon.
The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes.
Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist.
At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%).
In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.
自我们上次发表机器人前列腺切除术技术以来，我们已经引入了三项技术改进：超级神经保留、经皮耻骨上管（PST）膀胱引流和选择性患者的闭孔内和髂内淋巴结的有限淋巴结清扫，而不是髂外淋巴结。
描述选择标准，解释这三种技术，并评估功能和肿瘤学结果。
设计、地点和参与者：2006 年至 2008 年由一位外科医生进行的 1151 例根治性前列腺切除术的单机构研究。
超级神经保留技术保留了从 11 点位置到 1 点位置的神经。膀胱通过 PST 而不是导尿管引流。对于低危或中危疾病，有限的淋巴结清扫集中在髂内和闭孔淋巴结，不包括髂外淋巴结。
通过第三方提供的问卷评估勃起功能和患者舒适度。由合格的泌尿科病理学家定量评估淋巴结产量。
在手术后 6-18 个月，94%试图进行性行为的男性成功，中位数男性健康问卷调查（SHIM）得分为 25 分中的 18 分。PST 膀胱引流导致患者舒适度降低；视觉模拟评分在前列腺切除术后 2 天为 2，前列腺切除术后 6 天为 0。改良的淋巴结清扫术采集的总淋巴结很少，但在低风险分层患者中增加了阳性淋巴结的产量 13 倍以上（6.7%比 0.5%）。
在这项单机构、单外科医生研究中，这些改进改善了勃起功能结果，降低了与导管相关的不适，并增强了阳性淋巴结的检测。
