Barnet and Chase Farm NHS Trust, Enfield, London, UK.
Prostate Cancer Prostatic Dis. 2012 Mar;15(1):1-7. doi: 10.1038/pcan.2011.37. Epub 2011 Aug 16.
Robot-assisted radical prostatectomy (RARP) is the most commonly performed robotic procedure worldwide and is firmly established as a standard treatment option for localised prostate cancer. Part of the explanation for the rapid uptake of RARP is the reported gentler learning curve compared with the challenges of laparoscopic radical prostatectomy (LRP). However, robotic surgery is still fraught with potential difficulties and avoiding complications while on the steepest part of the learning curve is critical. Furthermore, as surgeons progress there is a tendency to take on increasingly complex cases, including patients with difficult anatomy and prior surgery, and these cases present a unique challenge. Significant intra-abdominal adhesions may be identified following open surgery, or dense periprostatic inflammation may be encountered following TURP; large prostate gland size and median lobes may alter bladder neck anatomy, making difficult subsequent urethro-vesical anastomosis. Even experienced robotic surgeons will be challenged by salvage RARP. Approaching these problems in a structured manner allows many of the problems to be overcome. We discuss some of the specific techniques to deal with these potential difficulties and highlight ways to avoid making serious mistakes.
机器人辅助根治性前列腺切除术（RARP）是全球最常进行的机器人手术，已被确立为局限性前列腺癌的标准治疗选择。RARP 迅速普及的部分原因是与腹腔镜根治性前列腺切除术（LRP）的挑战相比，报告的学习曲线更为平缓。然而，机器人手术仍然存在潜在的困难，在学习曲线最陡峭的部分避免并发症至关重要。此外，随着外科医生的进步，他们倾向于接受越来越复杂的病例，包括解剖结构困难和先前手术的患者，这些病例带来了独特的挑战。开放性手术后可能会发现明显的腹腔内粘连，或 TURP 后可能会遇到致密的前列腺周围炎症；前列腺体积大和中叶可能会改变膀胱颈部解剖结构，使得随后的尿道膀胱吻合术变得困难。即使是经验丰富的机器人外科医生也会受到挽救性 RARP 的挑战。以结构化的方式处理这些问题可以克服许多问题。我们讨论了一些处理这些潜在困难的具体技术，并强调了避免犯严重错误的方法。
