Tuğcu Volkan, Akça Oktay, Şimşek Abdulmuttalip, Yiğitbaşı İsmail, Şahin Selçuk, Taşçı Ali İhsan
Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Department of Urology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
Turk J Urol. 2017 Dec;43(4):476-483. doi: 10.5152/tud.2017.35488. Epub 2017 Dec 1.
Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot- assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP.
Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT device was placed and robotic system was docked.
The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m. Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients.
We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area.
微创技术不断发展，因其能降低手术所致的发病率和死亡率，并将手术技术挑战降至最低，故而更受青睐。尤其是根治性会阴前列腺切除术（RPP）存在一些挑战，比如在深部狭窄空间操作以及给外科医生带来有挑战性的人体工程学问题。由于这些问题，开放性RPP仍在经验丰富的中心开展。为了减少这些困难，研发了机器人辅助根治性会阴前列腺切除术（r-RPP）。在本研究中，我们报告了r-RPP的首例临床结果。
2016年11月至2017年2月期间，15例患者在我们中心接受了r-RPP手术。对所有患者进行多参数磁共振成像以排除局部进展性疾病。慢性阻塞性肺疾病患者和局部进展性前列腺癌患者未选用r-RPP方法。患者取15度头低脚高位的夸张截石位。切开并解剖皮下组织后，解剖推进至直肠后尿道肌纤维边缘。然后放置GelPOINT装置并对接机器人系统。
患者的平均年龄为60.2±7.8岁。患者的平均体重指数为28.8±1.9kg/m²。4例患者曾接受过重大腹部手术。术前平均前列腺特异性抗原值为7.3±2.4ng/mL。平均前列腺体积为40.8±12.4立方厘米。平均会阴解剖时间为60±10.1分钟。平均控制台操作时间和总手术时间分别为95±11.3分钟和167±37.4分钟。术后平均导尿时间为8.3±1.7天。拔除尿道导管后的早期控尿率为40%，在术后第3个月，所有患者的平均控尿率为94%。
我们证明r-RPP是一种可行且有效的方法。但该方法仍需在该领域进一步研究。
