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从纯腹腔镜到机器人辅助根治性前列腺切除术的转变:单外科医生机构的发展。

Transition from pure laparoscopic to robotic-assisted radical prostatectomy: a single surgeon institutional evolution.

机构信息

Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.

出版信息

Urol Oncol. 2010 Jan-Feb;28(1):81-5. doi: 10.1016/j.urolonc.2009.07.002.

Abstract

PURPOSE

To review a single surgeon experience of transitioning to a robotic-assisted laparoscopic prostatectomy program (RALP) with prior pure laparoscopic radical prostatectomy (LRP) experience.

MATERIALS AND METHODS

A retrospective review of surgical results from a single surgeon performing LRP transitioning to RALP was performed. Two hundred five patients undergoing RALP by a single, fellowship-trained, urologic oncologist were analyzed and compared with 45 patients undergoing LRP by the same surgeon. Operative, pathologic, and functional outcomes were evaluated. Validated questionnaires, including the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF), were utilized for assessing urinary and sexual parameters.

RESULTS

Preoperative parameters (age, PSA, Gleason score) were similar in both RALP and LRP groups. Operative time (190 vs. 299 minutes), estimated blood loss (253 vs. 299 ml), and length of stay (1.6 vs. 2.6 days) were reduced in RALP vs. LRP. Although not statistically significant, there was a trend toward fewer transfusions with RALP (2.0% vs. 4.4%) as well as a lower positive margin rate in organ-confined (pT2) disease (9.8%, RALP vs. 20%, LRP). Continence at 12 months was 94% following RALP as opposed to 82% after LRP. In preoperatively potent men undergoing bilateral nerve sparing procedures, RALP conferred 81% potency at 12 months as opposed to only 62% following LRP.

CONCLUSIONS

The transition from LRP to RALP, in concert with an institutional commitment to a successful robotic surgery program, has yielded superior operative, oncologic, and functional results.

摘要

目的

回顾一位具有纯腹腔镜根治性前列腺切除术(LRP)经验的外科医生转为机器人辅助腹腔镜前列腺切除术(RALP)的经验。

材料与方法

对一位接受过 LRP 并转为 RALP 的外科医生的手术结果进行回顾性分析。分析比较了 205 例由同一位接受过 fellowship培训的泌尿科肿瘤学家行 RALP 的患者和 45 例行 LRP 的患者。评估了手术、病理和功能结果。采用国际前列腺症状评分(IPSS)和国际勃起功能指数(IIEF)等经过验证的问卷评估尿和性功能参数。

结果

RALP 和 LRP 组的术前参数(年龄、PSA、Gleason 评分)相似。RALP 组的手术时间(190 分钟比 299 分钟)、估计失血量(253 毫升比 299 毫升)和住院时间(1.6 天比 2.6 天)均有所减少。虽然没有统计学意义,但 RALP 组的输血率(2.0%比 4.4%)和器官局限(pT2)疾病的阳性切缘率(9.8%,RALP 比 20%,LRP)呈下降趋势。RALP 组 12 个月时的尿控率为 94%,而 LRP 组为 82%。在术前勃起功能正常且行双侧神经保留手术的男性中,RALP 组 12 个月时的勃起功能为 81%,而 LRP 组为 62%。

结论

与机构致力于成功开展机器人手术项目相结合,从 LRP 转为 RALP 可获得更好的手术、肿瘤学和功能结果。

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