Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy,
Insights Imaging. 2013 Oct;4(5):711-21. doi: 10.1007/s13244-013-0280-6. Epub 2013 Sep 10.
Robot-assisted laparoscopic radical prostatectomy (RALRP) is currently accepted as the preferred minimally invasive surgical treatment for localised prostate cancer, with optimal oncologic and functional results. Despite growing surgical experience, reduced postoperative morbidity and hospital stays, RALRP-related complications may occur, which are severe in 5-7 % of patients and sometimes require reoperation. Therefore, in hospitals with an active urologic surgery, urgent diagnostic imaging is increasingly requested to assess suspected early complications following RALRP surgery.
Based upon our experience, this pictorial review discusses basic principles of the surgical technique, the optimal multidetector CT (MDCT) techniques to be used in the postoperative urologic setting, the normal postoperative anatomy and imaging appearances.
Afterwards, we review and illustrate the varied spectrum of RALRP-related complications including haemorrhage, urinary leaks, anorectal injuries, peritoneal changes, surgical site infections, abscess collections and lymphoceles, venous thrombosis and port site hernias.
Knowledge of surgical procedure details, appropriate MDCT acquisition techniques, and familiarity with normal postoperative imaging appearances and possible complications are needed to correctly perform and interpret early post-surgical imaging studies, particularly to identify those occurrences that require prolonged in-hospital treatment or surgical reintervention.
• Robot-assisted laparoscopic radical prostatectomy allows minimally invasive surgery of localised cancer • Urologic surgeons may request urgent imaging to assess suspected postoperative complications • Main complications include haemorrhage, urine leaks, anorectal injuries, infections and lymphoceles • Correct multidetector CT techniques allow identifying haematomas, active bleeding and extravasated urine • Imaging postoperative complications is crucial to assess the need for surgical reoperation.
机器人辅助腹腔镜根治性前列腺切除术（RALRP）目前被认为是治疗局限性前列腺癌的首选微创外科治疗方法，具有最佳的肿瘤学和功能结果。尽管手术经验不断增加，术后发病率和住院时间减少，但 RALRP 相关并发症仍可能发生，在 5-7%的患者中较为严重，有时需要再次手术。因此，在有积极泌尿外科手术的医院，越来越多地要求进行紧急诊断性影像学检查，以评估 RALRP 手术后疑似早期并发症。
根据我们的经验，本文通过图片回顾讨论了手术技术的基本原则、泌尿外科术后使用的最佳多排 CT（MDCT）技术、正常的术后解剖结构和影像学表现。
随后，我们回顾并阐述了 RALRP 相关并发症的各种表现，包括出血、尿漏、肛肠损伤、腹膜变化、手术部位感染、脓肿积聚和淋巴囊肿、静脉血栓形成和端口疝。
正确进行和解读术后早期影像学研究，特别是识别需要延长住院治疗或再次手术干预的情况，需要了解手术细节、适当的 MDCT 采集技术以及熟悉正常的术后影像学表现和可能的并发症。
• 机器人辅助腹腔镜根治性前列腺切除术可微创治疗局限性癌症。
• 泌尿外科医生可能会要求进行紧急影像学检查以评估疑似术后并发症。
• 主要并发症包括出血、尿漏、肛肠损伤、感染和淋巴囊肿。
• 正确的多排 CT 技术可识别血肿、活动性出血和外渗尿液。
• 对术后并发症进行影像学检查对于评估是否需要再次手术至关重要。
