Department of Urology, Henri Mondor Hospital, Créteil, France.
J Endourol. 2010 Apr;24(4):577-82. doi: 10.1089/end.2009.0069.
We investigated whether an intrafascial approach to prostatectomy would provide significantly improved outcomes compared with retropubic and laparoscopic approaches. We performed 50 radical prostatectomies with an intrafascial, nerve-sparing, laparoscopic, robot-assisted extraperitoneal approach.
From December 2007 to June 2008, 50 consecutive patients underwent nerve sparing surgery using the intrafascial technique with robotic assistance. All surgeries were performed by the same senior urologist. Patient characteristics and perioperative data were collected prospectively. Oncological outcomes were assessed by pathological examination and postoperative prostate-specific antigen levels. Functional outcomes, including continence, potency, and quality of life, were assessed from patient questionnaires.
The mean operative time was 127 minutes (range: 80-205), the mean hospital stay was 4.2 days (range: 2-9), and the mean catheterization time was 7.8 days (range: 4-11). No perioperative complications occurred. One patient required a transfusion at the postoperative stage. The overall positive surgical margin rate was 12%; adjusted by tumor, nodes, and metastasis stage, it was 9.5% in pT2 and 17% in pT3 disease. At the 1-month follow-up, 66% of the patients were continent (no pad), 12% presented a minimal stress urinary incontinence (1 pad), and 22% required >1 pad(s) per day. Further, 60% of patients exhibited potency (erection sufficient for intercourse: 30% without the use of phosphodiesterase 5 inhibitors, 30% required a phosphodiesterase 5 inhibitor) and the remaining 40% required prostaglandin injections.
An intrafascial approach with robotic assistance provided satisfactory early functional results with respect to postoperative continence and potency. Long-term oncological results remain to be assessed.
我们研究筋膜内前列腺切除术与经耻骨后和腹腔镜前列腺切除术相比是否能提供显著改善的结果。我们采用筋膜内、神经保留、腹腔镜、机器人辅助经腹途径进行了 50 例根治性前列腺切除术。
2007 年 12 月至 2008 年 6 月，50 例连续患者采用筋膜内技术和机器人辅助进行神经保留手术。所有手术均由同一位资深泌尿科医生完成。前瞻性收集患者特征和围手术期数据。通过病理检查和术后前列腺特异性抗原水平评估肿瘤学结果。通过患者问卷调查评估功能结果，包括尿控、勃起功能和生活质量。
平均手术时间为 127 分钟（范围：80-205），平均住院时间为 4.2 天（范围：2-9），平均导尿管时间为 7.8 天（范围：4-11）。无围手术期并发症发生。1 例患者在术后阶段需要输血。总的阳性切缘率为 12%；按肿瘤、淋巴结和转移分期调整后，T2 期为 9.5%，T3 期为 17%。在 1 个月的随访中，66%的患者尿控（无需使用尿垫），12%出现轻微压力性尿失禁（1 片尿垫），22%每天需要>1 片尿垫。此外，60%的患者有勃起功能（勃起足以进行性交：30%无需使用磷酸二酯酶 5 抑制剂，30%需要使用磷酸二酯酶 5 抑制剂），其余 40%需要前列腺素注射。
机器人辅助筋膜内方法在术后尿控和勃起功能方面提供了令人满意的早期功能结果。长期的肿瘤学结果仍有待评估。
