Takenaka Atsushi
Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
Yonago Acta Med. 2015 Sep;58(3):95-9. Epub 2015 Oct 14.
In recent years, robot-assisted radical cystectomy has received attention worldwide as a useful procedure that helps to overcome the limitations of open radical cystectomy. We compared the surgical technique, perioperative and oncological outcomes, and learning curve of robot-assisted radical cystectomy with those of open radical cystectomy. The indications for robot-assisted radical cystectomy are identical to those of open radical cystectomy. Relative contraindications are due to patient positioning in the Trendelenburg position for long periods. Urinary diversion is performed either extracorporeally with a small skin incision or intracorporeally with a totally robotic-assisted maneuver. Accordingly, robot-assisted radical cystectomy can be performed safely with an acceptable operative time, little blood loss, and low transfusion rates. The lymph node yield and positive surgical margin rate were not significantly different between robot-assisted radical cystectomy and open radical cystectomy. The survival rates after robot-assisted radical cystectomy are estimated to be similar to that after open radical cystectomy. However, the recurrence pattern is different between robot-assisted radical cystectomy and open radical cystectomy, i.e., extrapelvic lymph node recurrence and peritoneal carcinomatosis were more frequently found in patients who underwent robot-assisted radical cystectomy than in those who underwent open radical cystectomy. Further validation is necessary to prove the feasibility of oncological control. A steep learning curve is one of the benefits of the new technique. The experience of only 50 robot-assisted radical prostatectomies is a minimum requirement for performing feasible robot-assisted radical cystectomy, and surgeons who have performed only 30 surgeries can reach an acceptable level of quality for robot-assisted radical cystectomy.
近年来，机器人辅助根治性膀胱切除术作为一种有助于克服开放性根治性膀胱切除术局限性的实用手术，在全球范围内受到关注。我们比较了机器人辅助根治性膀胱切除术与开放性根治性膀胱切除术的手术技术、围手术期和肿瘤学结局以及学习曲线。机器人辅助根治性膀胱切除术的适应证与开放性根治性膀胱切除术相同。相对禁忌证是由于患者需要长时间处于头低脚高位。尿流改道术可通过小皮肤切口在体外进行，也可通过完全机器人辅助操作在体内进行。因此，机器人辅助根治性膀胱切除术可以安全地进行，手术时间可接受，出血量少，输血率低。机器人辅助根治性膀胱切除术与开放性根治性膀胱切除术之间的淋巴结获取量和手术切缘阳性率无显著差异。机器人辅助根治性膀胱切除术后的生存率估计与开放性根治性膀胱切除术后相似。然而，机器人辅助根治性膀胱切除术与开放性根治性膀胱切除术的复发模式不同，即接受机器人辅助根治性膀胱切除术的患者比接受开放性根治性膀胱切除术的患者更常出现盆腔外淋巴结复发和腹膜癌转移。需要进一步验证以证明肿瘤学控制的可行性。陡峭的学习曲线是这项新技术的一个优点。进行可行的机器人辅助根治性膀胱切除术的最低要求是仅有50例机器人辅助根治性前列腺切除术的经验，而仅进行过30例手术的外科医生也能达到机器人辅助根治性膀胱切除术可接受的质量水平。
