Johnston William K, Linsell Susan, Miller David, Ghani Khurshid R
1 Michigan Institute of Urology, Beaumont School of Medicine, Oakland University , Novi, Michigan.
2 Department of Urology, University of Michigan , Ann Arbor, Michigan.
J Endourol. 2017 Mar;31(3):283-288. doi: 10.1089/end.2016.0402. Epub 2017 Feb 6.
Laparoscopic access for robot-assisted radical prostatectomy (RARP) is often initiated in the periumbilical location. Palmer's point, located in the left upper quadrant, has been reported as an alternative access site for pelvic laparoscopy to reduce morbidity, but not widely reported among urologists. To better understand surgeons' preferences for access and its associated morbidity during RARP, we surveyed surgeons from two urologic organizations.
An anonymous online questionnaire (SurveyMonkey) consisting of 17 questions that assessed training, experience, and preferences for RARP was emailed in December 2014 and collected until February 2015 to members performing RARP of the Endourology Society (ES) and the Michigan Urological Society Improvement Collaborative (MUSIC). Surgeons were also asked to share their personal experience with a vascular, death or life-threatening event (DOLTE), or bowel injury during RARP.
Questionnaires were answered by 111 surgeons in total (ES, n = 71 and MUSIC, n = 40) with an estimated total response rate of 5.5%. In total, 77% reported prior experience with the Veress needle method before exposure to RARP and 71% of respondents primarily use the Veress needle for RARP, with 73% reporting access primarily at the periumbilical location. A personal experience with a vascular or a bowel injury during Veress needle insertion was reported in 18% and 9% of surgeons, respectively; furthermore, 26% of respondents were personally aware of at least 1 DOLTE among colleagues (5% reported 3 or more). The majority (56%) of respondents were unaware of Palmer's point, while among the minority aware of Palmer's point, only 33% reported ever using this location.
In this survey, surgeons most commonly access the abdomen at the periumbilical location with a Veress needle for RARP with the majority not aware or utilizing Palmer's point. Nearly one in five surgeons reported a personal experience with a vascular injury during access for RARP. Palmer's point, located away from major vasculature, may reduce the morbidity of access for RARP and warrants further awareness and study.
机器人辅助根治性前列腺切除术（RARP）的腹腔镜入路通常始于脐周位置。位于左上腹的帕尔默点已被报道为盆腔腹腔镜检查的另一种入路部位，以降低发病率，但在泌尿外科医生中尚未广泛报道。为了更好地了解外科医生在RARP期间对入路及其相关发病率的偏好，我们对两个泌尿外科组织的外科医生进行了调查。
2014年12月通过电子邮件发送了一份由17个问题组成的匿名在线问卷（SurveyMonkey），该问卷评估了RARP的培训、经验和偏好，并一直收集到2015年2月，对象是腔内泌尿外科协会（ES）和密歇根泌尿外科协会改进协作组（MUSIC）中进行RARP的成员。还要求外科医生分享他们在RARP期间发生血管、死亡或危及生命事件（DOLTE）或肠损伤的个人经历。
共有111名外科医生回答了问卷（ES组71名，MUSIC组40名），估计总回复率为5.5%。总体而言，77%的人报告在接触RARP之前有使用Veress针方法的经验，71%的受访者在RARP中主要使用Veress针，73%的人报告入路主要在脐周位置。分别有18%和9%的外科医生报告在插入Veress针时发生血管或肠损伤的个人经历；此外，26%的受访者个人知道同事中至少发生过1次DOLTE（5%报告发生过3次或更多）。大多数（56%）受访者不知道帕尔默点，而在少数知道帕尔默点的人中，只有33%报告曾使用过这个位置。
在本次调查中，外科医生在RARP中最常通过Veress针在脐周位置进入腹腔，大多数人不知道或未使用帕尔默点。近五分之一的外科医生报告在RARP入路期间有血管损伤的个人经历。位于远离主要血管的帕尔默点可能会降低RARP入路的发病率，值得进一步关注和研究。
