Department of Urology and Andrology, LKH Hall i.Tirol, Landeskrankenhaus Hall i.T., Milser Str. 10, 6060 Hall i.Triol, Austria.
World J Urol. 2012 Oct;30(5):625-31. doi: 10.1007/s00345-011-0714-z. Epub 2011 Jul 8.
The aim of this descriptive study was to demonstrate the feasibility and safety of the first true transurethral sutureless radical prostatectomy for prostate cancer in humans using the NOTES technique.
A 77-year-old man with clinically localized bilateral prostate cancer (Gleason 3 + 4 = 7 in 80% of 12 biopsy cores) and a serum PSA level of 2.1 ng/ml underwent our first natural orifice transurethral radical thulium laser prostatectomy within toto organ retrieval via sectio alta. The surgical procedure is described.
The procedure was completed successfully. Overall operation time was 312 min; laser time was 46 min with 151 KJ. Postoperative hemoglobin was 9.4 g/dl, and the hematocrit was 28%. A cystogram on the 7th postoperative day showed no signs of extravasation and the transurethral catheter was removed, and a flexible cystoscopy on the 9th day demonstrated a sufficient arbitrarily sphincter closure against irrigation flow.
The presented descriptive report demonstrates that natural orifice transurethral radical thulium laser prostatectomy for prostate cancer is feasible and safe. Potential candidates include older patients with low-risk cancers and urinary obstruction. Further prospective reports are necessary to evaluate functional and oncological outcome for this innovative technique.
本描述性研究旨在展示使用NOTES 技术进行首例真正的经尿道无缝合根治性前列腺切除术治疗前列腺癌的可行性和安全性。
一名 77 岁男性患有临床局限性双侧前列腺癌（12 个活检核心中有 80%为 Gleason 3+4=7），血清 PSA 水平为 2.1ng/ml，通过 sectio alta 进行了我们首例经自然腔道经尿道钬激光全前列腺切除术。描述了手术过程。
手术成功完成。总手术时间为 312 分钟；激光时间为 46 分钟，能量为 151KJ。术后血红蛋白为 9.4g/dl，血细胞比容为 28%。术后第 7 天行膀胱造影未见外渗迹象，拔除经尿道导尿管，术后第 9 天行软性膀胱镜检查显示括约肌对冲洗流量有足够的随意性闭合。
本描述性报告表明，经自然腔道经尿道钬激光前列腺切除术治疗前列腺癌是可行且安全的。潜在的候选者包括患有低危癌症和尿路梗阻的老年患者。需要进一步的前瞻性报告来评估这项创新技术的功能和肿瘤学结果。
