Kaufmann Oskar G, Young Jennifer L, Sountoulides Petros, Kaplan Adam G, Dash Atreya, Ornstein David K
University of California, Irvine, California , USA.
Minim Invasive Ther Allied Technol. 2011 Jul;20(4):240-6. doi: 10.3109/13645706.2010.541711. Epub 2010 Dec 13.
Robotic technology may be a promising tool in reduction of morbidity in radical anterior pelvic exenteration for invasive bladder cancer. We report our initial experience with robotic-assisted radical anterior pelvic exenteration in females in an attempt to evaluate the technique's feasibility and outcomes. A retrospective review of our bladder cancer database was performed. Twelve women that underwent robotic-assisted radical anterior pelvic exenteration, bilateral pelvic lymphadenectomy, and urinary diversion for clinically localized urothelial carcinoma of the bladder between 2004 and 2008 were included in this retrospective study. Median age was 73.0 +/- 9.6 years and median body mass index (BMI) was 23.5 +/- 5.0 kg/m2. Ten patients underwent ileal conduit diversion, one had an orthotopic neobladder and one an Indiana pouch. Median total operating time was 6.4 +/- 1.5 hours with median console and diversion times of 4.7 +/- 0.9 and 2.5 +/- 1.5 hours respectively. Median blood loss was 275.0 +/- 165.8 ml. Median length of stay was 8.0 +/- 1.6 days. Four patients were T2N0 or less, five T3N0, one T3N1 and two patients T4N0. There was one patient with positive surgical margins. Median number of lymph nodes removed was 23.0 +/- 11.4. Median follow-up of 9.0 +/- 6.0 months was available for ten patients. One had a recurrent ureteroenteric stricture, one had colpocleisis for vault prolapse, and three had metastatic disease. Robotic-assisted laparoscopic anterior pelvic exenteration appears to be a favorable surgical option with acceptable operative, pathological, and short-term clinical outcomes. According to the UCI experience, robotic anterior exenteration appears to achieve the clinical and oncologic goals for the surgical treatment of bladder cancer.
机器人技术可能是降低浸润性膀胱癌根治性前盆腔脏器清除术发病率的一种有前景的工具。我们报告了我们在女性患者中进行机器人辅助根治性前盆腔脏器清除术的初步经验，以评估该技术的可行性和效果。我们对膀胱癌数据库进行了回顾性分析。本回顾性研究纳入了2004年至2008年间接受机器人辅助根治性前盆腔脏器清除术、双侧盆腔淋巴结清扫术及尿流改道治疗临床局限性膀胱尿路上皮癌的12名女性患者。中位年龄为73.0±9.6岁，中位体重指数（BMI）为23.5±5.0kg/m²。10例患者接受了回肠导管尿流改道，1例接受了原位新膀胱术，1例接受了印第安纳袋术。中位总手术时间为6.4±1.5小时，中位控制台操作时间和尿流改道时间分别为4.7±0.9小时和2.5±1.5小时。中位失血量为275.0±165.8ml。中位住院时间为8.0±1.6天。4例患者为T2N0或更低分期，5例为T3N0，1例为T3N1，2例为T4N0。有1例患者手术切缘阳性。中位切除淋巴结数为23.0±11.4个。10例患者的中位随访时间为9.0±6.0个月。1例出现复发性输尿管肠吻合口狭窄，1例因穹窿脱垂行阴道闭合术，3例出现转移性疾病。机器人辅助腹腔镜前盆腔脏器清除术似乎是一种有利的手术选择，具有可接受的手术、病理和短期临床效果。根据加州大学欧文分校的经验，机器人前盆腔脏器清除术似乎实现了膀胱癌手术治疗的临床和肿瘤学目标。
