Su Jian, Zhu Qingyi, Yuan Lin, Zhang Yang, Zhang Qingling, Wei Yunfei
Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China.
BJU Int. 2018 Jan;121(1):111-118. doi: 10.1111/bju.13965. Epub 2017 Aug 17.
To describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site (LESS) radical prostatectomy (RP) and LESS radical cystectomy (RC) in a single institution.
Between December 2014 and March 2016, a total of 114 LESS RPs and RCs were performed, comprising 68 LESS RPs, 38 LESS RCs with cutaneous ureterostomy (CU) and eight LESS RCs with orthotopic ileal neobladder (OIN). Access was achieved via a single-port, with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port ('Zhu's port') was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The peri-operative and postoperative data were collected and analysed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects.
All the procedures were completed successfully. No conversion to conventional laparoscopic surgery was necessary. For LESS RP, the average operating time was 152 min. Estimated blood loss was 117 mL. The mean hospital stay was 16.4 days after surgery. For LESS RC with CU and LESS RC with OIN, the mean operating times were 215 and 328 min, mean estimated blood loss was 175 and 252 mL, and mean hospital stay was 9.4 and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intra-operative complications occurred in two patients (1.75%), and postoperative complications in nine (7.89%). Fourteen out of 68 (20.6%) patients who underwent LESS RP had positive surgical margins. Follow-up ranged from 10 to 30.6 months. In the prostate cancer cases, good urinary control was observed in 35.3%, 97.1% and 100% of patients at 1, 6 and 12 months after the operation, respectively, while biochemical recurrence was observed in 11.8% patients. In the bladder cancer cases, two patients had local recurrence and two patients had distant metastasis.
Our results showed that LESS RP and LESS RC are feasible and safe with the aid of a transurethral port. Operating through the transurethral port might overcome the challenges posed by the single-port laparoscopic approach.
描述经尿道辅助腹腔镜单孔（LESS）根治性前列腺切除术（RP）及LESS根治性膀胱切除术（RC）的手术技术，并报告单一机构的早期手术结果。
2014年12月至2016年3月期间，共实施了114例LESS RP和RC手术，其中包括68例LESS RP、38例带皮肤输尿管造口术（CU）的LESS RC以及8例带原位回肠新膀胱术（OIN）的LESS RC。通过单孔实现手术入路，经脐部切口置入四个通道。在前列腺尖部与尿道分离后，经尿道插入自行研发的端口（“朱氏端口”），以利于前列腺切除及尿道膀胱吻合。回顾性收集并分析围手术期和术后数据。对患者进行术后随访，观察长期副作用情况。
所有手术均成功完成，无需转为传统腹腔镜手术。对于LESS RP，平均手术时间为152分钟，估计失血量为117毫升，术后平均住院时间为16.4天。对于带CU的LESS RC和带OIN的LESS RC，平均手术时间分别为215分钟和328分钟，平均估计失血量分别为175毫升和252毫升，平均住院时间分别为9.4天和18.2天。6例患者需要输血（5.26%）。术中并发症发生在2例患者（1.75%），术后并发症发生在9例患者（7.89%）。68例接受LESS RP的患者中有14例（20.6%）手术切缘阳性。随访时间为10至30.6个月。在前列腺癌病例中，术后1、6和12个月时，分别有35.3%、97.1%和100%的患者尿控良好，11.8%的患者出现生化复发。在膀胱癌病例中，2例患者出现局部复发，2例患者出现远处转移。
我们的结果表明，借助经尿道端口，LESS RP和LESS RC是可行且安全的。通过经尿道端口进行手术可能克服单孔腹腔镜手术方法带来的挑战。
