Department of Urology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Urology. 2011 Dec;78(6):1211-7. doi: 10.1016/j.urology.2011.06.056. Epub 2011 Oct 11.
To describe the first clinical experience, pathologic, and perioperative outcomes of natural orifice transluminal endoscopic surgery (NOTES) radical prostatectomy. NOTES represents the evolution of minimally invasive surgery. The conceptual feasibility has been shown in careful laboratory and animal studies, but a scarcity of information regarding clinical applications exists.
After institutional review board approval, 2 patients agreed to undergo NOTES radical prostatectomy for localized prostate cancer. The prostate was radically resected using a 26F resectoscope, 550-μm laser fiber, and holmium laser. The prostate was delivered into the bladder and removed at the conclusion of the procedure through a suprapubic cystotomy for histopathologic analysis. The vesicourethral anastomosis was completed using a cannula scope, urethral-vesical suturing device, and titanium knot applier. Cystograms were taken immediately postoperatively and at catheter removal.
Both patients tolerated the procedure without operative complications. All intraoperative cystograms showed watertight anastomoses. The pathologic examination revealed Gleason score 3 + 3 and Stage pT2aNxMx for 1 patient and Gleason score 3 + 4 and Stage pT2cNxMx for 1 patient, with negative margins for both. No blood transfusions were required. Patient 2 experienced some left-sided gluteal and suprapubic pain postoperatively.
NOTES radical prostatectomy appears to be a safe and feasible option for the management of carefully selected, organ-confined prostate cancer. The perioperative and pathologic outcomes show promise with this new technique; however, the high standards of oncologic and functional outcomes demand close and longer follow-up before adoption into the surgical armamentarium can be recommended.
描述经自然腔道内镜手术（NOTES）根治性前列腺切除术的首例临床经验、病理和围手术期结果。NOTES 代表了微创手术的发展。在仔细的实验室和动物研究中已经证明了其概念的可行性，但关于临床应用的信息却很少。
在机构审查委员会批准后，2 名患者同意接受经自然腔道内镜手术根治性前列腺切除术治疗局限性前列腺癌。使用 26F 电切镜、550μm 激光纤维和钬激光彻底切除前列腺。在手术结束时，将前列腺通过耻骨上膀胱造口送入膀胱并取出，用于组织病理学分析。使用套管镜、尿道膀胱吻合器和钛结固定器完成尿道膀胱吻合。术后立即和拔除导尿管后进行膀胱造影。
两名患者均耐受手术，无手术并发症。所有术中膀胱造影均显示吻合严密。病理检查显示，1 例患者的 Gleason 评分为 3+3，分期为 pT2aNxMx，另 1 例患者的 Gleason 评分为 3+4，分期为 pT2cNxMx，均为阴性切缘。无需输血。患者 2 术后出现左侧臀部和耻骨上疼痛。
经自然腔道内镜根治性前列腺切除术似乎是一种安全可行的选择，适用于精心选择的局限性前列腺癌患者。该新技术的围手术期和病理结果显示出良好的前景；然而，在推荐将其纳入手术器械之前，需要进行密切和更长时间的随访，以确保达到肿瘤学和功能学的高标准。
