Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5046, USA.
J Endourol. 2010 Oct;24(10):1625-9. doi: 10.1089/end.2010.0151.
In the era of prostate-specific antigen screening and frequent cross-sectional abdominal imaging, concurrent prostate cancer and renal masses are being identified and treated. Minimizing patient morbidity and cost by avoiding separate surgical procedures is advantageous, provided technical feasibility, and safety data. Our goal was to assess the feasibility and safety of single-setting robotic renal surgery and prostatectomy. We present our initial experience.
To assess the feasibility and safety of single-setting concurrent robot-assisted renal surgery and radical prostatectomy utilizing the same port access scheme.
From February 2009 to June 2009, we performed single-setting concurrent robot-assisted radical nephrectomy/partial nephrectomy and radical prostatectomy on two patients with synchronous kidney tumors and prostate cancer. Identical port sites were used during both aspects of the procedure with the exception of one additional port during prostatectomy. Prostate cancer clinical stage and Gleason scores were T1c and 6 and T2a and 7, respectively. Corresponding renal tumors were 5 cm, respectively.
Both operations were performed, with no conversion to open surgery. There were no intraoperative complications and the postoperative course was uneventful in both patients. Discharge was on postoperative day 2 and 3, respectively. Patient 2 had an episode of delayed bleeding on postoperative day 9, treated by selective angio-embolization. Mean operative time for nephrectomy and prostatectomy (135 and 139 minutes, respectively) and estimated blood loss (75 and 100 mL, respectively) were reasonable. We began with the renal portion utilizing a lateral decubitus position before re-positioning into the lithotomy position for the prostatic portion. Clamping time was 34 minutes during partial nephrectomy.
Single-setting robotic radical/partial nephrectomy and radical prostatectomy is technically feasible and safe in properly selected patients who present with synchronous primary renal and prostate malignancies.
在前列腺特异性抗原筛查和频繁的横断面腹部成像时代，同时发现和治疗前列腺癌和肾肿瘤。通过避免单独的手术程序来最大限度地减少患者的发病率和成本是有利的，只要技术上可行并且有安全性数据。我们的目标是评估单次设置机器人辅助肾手术和前列腺切除术的可行性和安全性。我们介绍了初步经验。
评估使用相同端口访问方案在单次设置中同时进行机器人辅助肾切除术和根治性前列腺切除术的可行性和安全性。
从 2009 年 2 月至 2009 年 6 月，我们对两名同时患有肾肿瘤和前列腺癌的患者进行了单次设置同时进行机器人辅助根治性肾切除术/部分肾切除术和根治性前列腺切除术。在手术的两个方面都使用了相同的端口部位，但在前列腺切除术中使用了一个额外的端口。前列腺癌的临床分期和 Gleason 评分分别为 T1c 和 6 以及 T2a 和 7，相应的肾肿瘤分别为 5 厘米。
两项手术均成功完成，无中转开放手术。术中无并发症，两名患者术后恢复顺利。分别于术后第 2 天和第 3 天出院。患者 2 于术后第 9 天出现延迟性出血，经选择性血管栓塞治疗。肾切除术和前列腺切除术的平均手术时间（分别为 135 分钟和 139 分钟）和估计失血量（分别为 75 毫升和 100 毫升）合理。我们先进行肾部分切除术，然后采用侧卧位，再重新定位到截石位进行前列腺部分切除术。部分肾切除术的夹闭时间为 34 分钟。
在适当选择的同时患有原发性肾和前列腺恶性肿瘤的患者中，单次设置机器人根治性/部分肾切除术和根治性前列腺切除术在技术上是可行且安全的。
