Akand Murat, Erdogru Tibet, Avci Egemen, Ates Mutlu
Department of Urology, School of Medicine, Selcuk University, Konya, Turkey.
Departments of Urology and Minimally Invasive & Robotic Surgery, Memorial Atasehir Hospital, Istanbul, Turkey.
Int J Urol. 2015 Oct;22(10):916-21. doi: 10.1111/iju.12854. Epub 2015 Jul 26.
To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy carried out by a single surgeon.
After having experience with 32 transperitoneal laparoscopic radical prostatectomies, 317 extraperitoneal laparoscopic radical prostatectomies, 30 transperitoneal robot-assisted laparoscopic radical prostatectomies and 10 extraperitoneal robot-assisted laparoscopic radical prostatectomies, 120 patients with prostate cancer were enrolled in this prospective randomized study and underwent either transperitoneal or extraperitoneal robot-assisted laparoscopic radical prostatectomy. The main outcome parameters between the two study groups were compared.
No significant difference was found for age, body mass index, preoperative prostate-specific antigen, clinical and pathological stage, Gleason score on biopsy and prostatectomy specimen, tumor volume, positive surgical margin, and lymph node status. Transperitoneal robot-assisted laparoscopic radical prostatectomy had shorter trocar insertion time (16.0 vs 25.9 min for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, P < 0.001), whereas extraperitoneal robot-assisted laparoscopic radical prostatectomy had shorter console time (101.5 vs 118.3 min, respectively, P < 0.001). Total operation time and total anesthesia time were found to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy, without statistical significance (200.9 vs 193.2 min; 221.8 vs 213.3 min, respectively). Estimated blood loss was found to be lower for extraperitoneal robot-assisted laparoscopic radical prostatectomy (P = 0.001). Catheterization and hospitalization times were observed to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (7.3 vs 5.8 days and 3.1 vs 2.3 days for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, respectively, P < 0.05). The time to oral diet was significantly shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (32.3 vs 20.1 h, P = 0.031). Functional outcomes (continence and erection) and complication rates were similar in both groups.
Extraperitoneal robot-assisted laparoscopic radical prostatectomy seems to be a good alternative to transperitoneal robot-assisted laparoscopic radical prostatectomy with similar operative, pathological and functional results. As the surgical field remains away from the bowel, postoperative return to normal diet and early discharge can be favored.
比较由同一位外科医生实施的经腹与腹膜外机器人辅助腹腔镜根治性前列腺切除术的手术、病理及功能结果。
在积累了32例经腹腹腔镜根治性前列腺切除术、317例腹膜外腹腔镜根治性前列腺切除术、30例经腹机器人辅助腹腔镜根治性前列腺切除术及10例腹膜外机器人辅助腹腔镜根治性前列腺切除术的经验后，120例前列腺癌患者被纳入这项前瞻性随机研究，并接受经腹或腹膜外机器人辅助腹腔镜根治性前列腺切除术。对两个研究组之间的主要结局参数进行比较。
在年龄、体重指数、术前前列腺特异性抗原、临床及病理分期、活检及前列腺切除标本的Gleason评分、肿瘤体积、手术切缘阳性及淋巴结状态方面未发现显著差异。经腹机器人辅助腹腔镜根治性前列腺切除术的套管插入时间较短（经腹机器人辅助腹腔镜根治性前列腺切除术为16.0分钟，腹膜外机器人辅助腹腔镜根治性前列腺切除术为25.9分钟，P<0.001），而腹膜外机器人辅助腹腔镜根治性前列腺切除术的控制台操作时间较短（分别为101.5分钟和118.3分钟，P<0.001）。腹膜外机器人辅助腹腔镜根治性前列腺切除术的总手术时间和总麻醉时间较短，但无统计学意义（分别为200.9分钟和193.2分钟；221.8分钟和213.3分钟）。腹膜外机器人辅助腹腔镜根治性前列腺切除术的估计失血量较低（P = 0.001）。观察到腹膜外机器人辅助腹腔镜根治性前列腺切除术的导尿时间和住院时间较短（经腹机器人辅助腹腔镜根治性前列腺切除术和腹膜外机器人辅助腹腔镜根治性前列腺切除术分别为7.3天和5.8天，3.1天和2.3天，P<0.05）。腹膜外机器人辅助腹腔镜根治性前列腺切除术的恢复经口饮食时间明显较短（32.3小时和20.1小时，P = 0.031）。两组的功能结局（控尿和勃起）及并发症发生率相似。
腹膜外机器人辅助腹腔镜根治性前列腺切除术似乎是经腹机器人辅助腹腔镜根治性前列腺切除术的一个良好替代方案，手术、病理及功能结果相似。由于手术视野远离肠道，有利于术后恢复正常饮食和早期出院。
Zotero 插件