Shimbo Masaki, Hattori Kazunori, Endo Fumiyasu, Matsushita Kazuhito, Iwabuchi Toshihisa, Tobisu Kenichi, Muraishi Osamu
Department of Urology, St. Luke's International Hospital, Tokyo, Japan.
Int J Urol. 2014 Sep;21(9):946-8. doi: 10.1111/iju.12481. Epub 2014 May 13.
To evaluate the feasibility and reproducibility of a simple technique for identifying the initial cutting point of the bladder neck during robot-assisted radical prostatectomy. To precisely identify the prostatovesical junction, we first pulled the anterior bladder wall in an upward direction with the second arm to identify the precise location of the prostatovesical junction where anterior bladder neck dissection is initiated. After one experienced surgeon had established this technique, three surgeons who were less experienced in robot-assisted radical prostatectomy utilized this method for 50 consecutive robot-assisted radical prostatectomy cases. The pathological results and the time required to transect the anterior bladder wall were evaluated. There were no cases of positive resection margin on the site of bladder neck. The mean resection time was not significantly different when comparing less experienced surgeons with the experienced surgeon (P = 0.29). In conclusion, this method is a simple and reproducible way to identify the bladder neck during robot-assisted radical prostatectomy. This technique is also useful (for laparoscopic or open radical prostatectomy) even in difficult scenarios, such as post-transurethral resection of prostate cases.
评估一种用于在机器人辅助根治性前列腺切除术中确定膀胱颈初始切割点的简单技术的可行性和可重复性。为了精确识别前列腺膀胱交界处，我们首先用第二臂向上牵拉膀胱前壁，以确定开始膀胱颈前部解剖的前列腺膀胱交界处的确切位置。在一位经验丰富的外科医生确立了该技术后，三位在机器人辅助根治性前列腺切除术方面经验较少的外科医生连续对50例机器人辅助根治性前列腺切除术病例采用了该方法。评估了病理结果和横断膀胱前壁所需的时间。膀胱颈部位没有切缘阳性的病例。将经验较少的外科医生与经验丰富的外科医生进行比较时，平均切除时间没有显著差异（P = 0.29）。总之，该方法是在机器人辅助根治性前列腺切除术中识别膀胱颈的一种简单且可重复的方法。即使在困难的情况下，如经尿道前列腺切除术后的病例，该技术（对于腹腔镜或开放根治性前列腺切除术）也很有用。
