University Hospitals Urology Institute, Cleveland, OH, USA.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol. 2015 Jul;68(1):86-94. doi: 10.1016/j.eururo.2014.11.044. Epub 2014 Dec 4.
Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique.
To report a large multi-institutional series of minimally invasive SP (MISP).
DESIGN, SETTING, AND PARTICIPANTS: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis.
Laparoscopic or robotic SP.
Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15ml/s, and no perioperative complications.
Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100ml (range: 89-128). Median estimated blood loss was 200ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p=0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p=0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss (p=0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis.
This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications.
Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.
腹腔镜和机器人前列腺单纯切除术（SP）的引入旨在降低标准开放技术的发病率。
报告一项大型多机构微创 SP（MISP）系列研究。
设计、地点和参与者：回顾性分析了 2000 年至 2014 年间在美洲和欧洲的 23 个参与机构，因良性前列腺增生（BPE）引起的膀胱出口梗阻（BOO）而连续进行的微创 SP（MISP）治疗病例。
腹腔镜或机器人 SP。
收集并分析人口统计学数据和主要围手术期结果。进行了多变量分析，以确定与有利的三联征结果相关的因素，三联征结果任意定义为以下术后事件的组合：国际前列腺症状评分<8、最大尿流率>15ml/s 和无围手术期并发症。
总体而言，分析了 1330 例连续病例，包括 487 例机器人（36.6%）和 843 例腹腔镜（63.4%）SP 病例。中位前列腺总体积为 100ml（范围：89-128）。中位估计失血量为 200ml（范围：150-300）。术中需要输血的比例为 3.5%，术中记录并发症的比例为 2.2%，转化率为 3%。中位住院时间为 4 天（范围：3-5 天）。病理检查发现 4%的病例有前列腺癌。总体术后并发症发生率为 10.6%，大多为低级别。中位随访 12 个月时，观察到 BOO 的主观和客观指标显著改善。三联征结果不受手术类型（机器人与腹腔镜；p=0.136；比值比[OR]：1.6；95%置信区间[CI]，0.8-2.9）的影响，而手术时间（p=0.01；OR：0.9；95%CI，0.9-1.0）和估计失血量（p=0.03；OR：0.9；95%CI，0.9-1.0）是唯一两个有统计学意义的因素。回顾性研究设计、缺乏对照组和有限的随访是本分析的主要局限性。
本研究提供了最大的 MISP 治疗 BOO/BPE 结果分析。这些发现证实，在具有特定手术专业知识和技术的各种医疗保健环境中，可以安全有效地进行微创 SP。MISP 可被视为治疗大前列腺腺瘤的一种可行的手术治疗方法。对于有机器人程序用于治疗其他泌尿科疾病的中心，可以考虑将机器人技术用于该适应证。
来自多个机构的大型数据集分析表明，通过使用机器人辅助腹腔镜手术，可以安全有效地切除有症状的大前列腺腺瘤。
