Zhu Jie, Gao Jiang-ping, Xu A-xiang, Wang Wei, Dong Jun, Cui Liang, Zhang Ke, Zhang Xu
Department of Urology, General Hospital of People's Liberation Army, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 15;47(16):1242-4.
To present the technique and experience of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system.
From December 2007 to September 2008, 4 patients underwent RARC and urinary diversion. The age of patients was 44 to 63 years old. The body mass index was 22.8 to 27.7. All their clinical stages were lower than T2N0M0. The technique for RARC involving ureters dissection, posterior dissection, lateral pedicle control, anterior dissection, dorsal vein complex control, neurovascular bundles sparing, lymphadenectomy, ureter-ileal anastomosis, urethra-neobladder anastomosis to either ileal conduit urinary diversion or neobladder reconstruction performed extracorporeally.
All the operations were accomplished successfully. The urinary diversion of 2 case was ileal conduit and others was ileal orthophoria neobladder. The operation time was 300 to 450 min. The time of radical cystectomy was 150 to 180 min. The estimated blood loss was 100 to 500 ml. The postoperative hospital stay was 9 to 35 d. The bed rest time was 4 to 9 d. There was 1 patients who had incomplete intestinal obstruction at 8th postoperative day cured by conservative therapy. The patients were followed up for 3 to 12 months, all patients survived without tumor recurrence. The patients have satisfied urinary continence and normal renal functions without hydronephrosis after the operation.
RARC is small incision and safe, the results are definite. It is one of the direction of minimally invasive urologic surgery.
介绍运用达芬奇手术系统进行机器人辅助腹腔镜根治性膀胱切除术（RARC）的技术及经验。
2007年12月至2008年9月，4例患者接受了RARC及尿流改道术。患者年龄44至63岁。体重指数为22.8至27.7。所有患者临床分期均低于T2N0M0。RARC技术包括输尿管游离、后方游离、侧蒂控制、前方游离、背静脉复合体控制、保留神经血管束、淋巴结清扫、输尿管-回肠吻合、尿道-新膀胱吻合，以及回肠代膀胱尿流改道术或新膀胱重建术均在体外进行。
所有手术均成功完成。2例患者行回肠代膀胱尿流改道术，其余患者行回肠原位新膀胱术。手术时间为300至450分钟。根治性膀胱切除术时间为150至180分钟。估计失血量为100至500毫升。术后住院时间为9至35天。卧床休息时间为4至9天。1例患者术后第8天出现不完全性肠梗阻，经保守治疗治愈。患者随访3至12个月，所有患者均存活，无肿瘤复发。术后患者尿控满意，肾功能正常，无肾积水。
RARC切口小且安全，效果确切。是微创泌尿外科手术的发展方向之一。
