Departments of Urology and Urological Science Institute,Yonsei University College of Medicine, Seoul, Korea.
Int J Urol. 2010 Mar;17(3):297-300. doi: 10.1111/j.1442-2042.2010.02480.x.
We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports were placed medially and caudally in patients with a small pelvis to avoid interference between the ports and the pelvis (modified port configuration). Lymph node dissection is carried out in the external iliac, obturator and infraobturator area. The dissection on the lateral border of the bladder neck is carried out until it reaches the seminal vesicle (ultradissection). After transection of the bladder neck, vasa seminal vesicles are dissected further. Neurovascular bundles are preserved in selected patients. The dorsal venous complex (DVC) and the urethra are transected without suturing. Urethrovesical anastomosis is carried out with 3-0 monocryl running suture, incorporating with the edge of DVC. The puboprostatic collar and bladder are incorporated by 3-0 monocryl running suture (puboperineoplasty). Between November 2007 and September 2008, RARP was carried out using this technique in 182 patients. Median height, weight, body mass index and prostate-specific antigen (PSA) were 168 cm, 68 kg, 24 kg/M(2) and 7.1 ng/mL, respectively. Mean operative time was 192 min and average blood loss was 250 mL. Median catheterization time was 8 days. Positive surgical margin rates for pT2, pT3 and pT4 disease was 12.7, 48 and 100%, respectively. Intraoperative complication rate was 2.7%. Fifty-five patients completed a minimum of 10 months follow up. Their continence rate was 91%. RARP is a safe and feasible surgical modality for prostate cancer among Asian patients with a small pelvis. Our technique achieves a precise bladder neck dissection.
我们目前已经完成了超过 360 例机器人辅助腹腔镜前列腺根治术（RARP）。在本研究中，我们详细介绍了延世大学医学院目前使用的技术。采用经腹六孔法，对于骨盆较小的患者，最外侧的两个端口置于内侧和尾侧，以避免端口与骨盆之间的干扰（端口配置改良）。在髂外、闭孔和闭孔下区域进行淋巴结清扫。在膀胱颈外侧缘进行解剖，直到到达精囊（超解剖）。在切断膀胱颈后，进一步解剖输精管。在选择的患者中保留神经血管束。不缝合地横断背静脉复合体（DVC）和尿道。使用 3-0 单丝连续缝合进行尿道膀胱吻合，同时包括 DVC 的边缘。用 3-0 单丝连续缝合将前列腺包膜和膀胱（耻骨前列腺切除术）缝合在一起。2007 年 11 月至 2008 年 9 月，我们使用这种技术对 182 例患者进行了 RARP。患者的平均身高、体重、体重指数和前列腺特异性抗原（PSA）分别为 168cm、68kg、24kg/m2 和 7.1ng/ml。平均手术时间为 192 分钟，平均出血量为 250ml。中位导尿时间为 8 天。pT2、pT3 和 pT4 疾病的阳性切缘率分别为 12.7%、48%和 100%。术中并发症发生率为 2.7%。55 例患者完成了至少 10 个月的随访，其控尿率为 91%。RARP 是一种安全可行的治疗亚洲小骨盆前列腺癌的手术方法。我们的技术可以实现精确的膀胱颈解剖。
