Bagla Sandeep, Smirniotopoulos John, Orlando Julie C, Piechowiak Rachel
Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA.
New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
Cardiovasc Intervent Radiol. 2017 Mar;40(3):360-365. doi: 10.1007/s00270-016-1514-z. Epub 2016 Nov 21.
Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH.
IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months.
No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred.
Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.
前列腺动脉栓塞术（PAE）是治疗良性前列腺增生（BPH）的一种安全有效的方法，尽管在技术上具有挑战性。我们介绍了机器人辅助和手动PAE治疗BPH患者的技术和临床结果经验。
2014年5月至2015年7月，对40例年龄在49 - 81岁的中重度BPH患者进行了经机构审查委员会批准的回顾性研究：20例机器人辅助PAE（第1组），20例手动PAE（第2组）。使用麦哲伦机器人系统进行机器人辅助PAE。回顾了美国泌尿外科学会（AUA-SI）评分、成本、技术和临床成功率、辐射剂量、透视时间和手术时间。分别在1个月和3个月时，使用配对t检验和单因素方差分析在每组内部和组间进行统计分析。
两组间年龄和AUA-SI的基线无显著差异。技术成功率第1组为100%，第2组为95%。第2组的1例未成功患者在机器人辅助下再次进行栓塞，获得成功。两组间透视时间和手术时间相似，第1组患者辐射剂量略低，但差异无统计学意义（30,632.8 mGy/cm对35,890.9，p = 0.269）。两组间一次性成本有显著差异，机器人辅助PAE成本更高（第1组4530.2美元；第2组1588.5美元，p < 0.0001）。3个月时两组临床均有显著改善：第1组AUA-SI平均变化8.3（p = 0.006），第2组：9.6（p < 0.0001）。未发生轻微或严重并发症。
机器人辅助PAE的技术成功率与手动PAE相当，临床改善相似，但成本增加。
