USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Verona, Italy.
BJU Int. 2018 Aug;122(2):344-348. doi: 10.1111/bju.14203. Epub 2018 May 9.
To present the step-by-step technique of a 360° mucosal reconstruction after transvesical robot-assisted simple prostatectomy (RASP).
We analysed the first 23 consecutive patients who underwent RASP using our 360° reconstruction between December 2015 and October 2017. After transperitoneal intravesical adenoma enucleation, a circumferential 360° reconstruction is performed. The first suture is placed at the 9 o'clock position and the edge of the urethra and bladder mucosa is approximated using 2-0 barbed suture. The reconstruction is continued counter-clockwise and the bladder mucosa is approximated to the urethra circumferentially.
The mean (sd) operating time was 160.6 (28.1) min and the estimated blood loss was 98.6 (99.8) mL. No patients required conversion to open surgery. No intra-operative or postoperative transfusions were needed. No intra-operative complications occurred. The mean (sd) length of hospital stay was 2.1 (0.6) days. One postoperative complication was reported (respiratory distress in a patient with chronic obstructive pulmonary disease, requiring intensive care unit admission).
Our 360° reconstruction during RASP is feasible and safe. The aim of the technique is to minimize use of electrocautery and decrease the raw surface area on the prostate capsule. This technical modification could potentially lessen postoperative bleeding after RASP and therefore the need for continuous bladder irrigation. In addition, it could potentially lead to mitigation of burning and irritative postoperative symptoms. Longer follow-up and comparative studies of different RASP techniques are still needed.
介绍经膀胱机器人辅助单纯前列腺切除术（RASP）后 360°黏膜重建的分步技术。
我们分析了 2015 年 12 月至 2017 年 10 月期间接受我们的 360°重建的 23 例连续 RASP 患者。经腹膜内膀胱内腺瘤剜除术后，进行 360°环形重建。第一针缝线位于 9 点钟位置，用 2-0 倒钩缝线将尿道边缘和膀胱黏膜靠拢。重建逆时针进行，膀胱黏膜环绕尿道靠拢。
平均（标准差）手术时间为 160.6（28.1）分钟，估计出血量为 98.6（99.8）毫升。无患者需要转为开放手术。术中或术后无需输血。无术中并发症发生。平均（标准差）住院时间为 2.1（0.6）天。报告了 1 例术后并发症（慢性阻塞性肺疾病患者呼吸窘迫，需要入住重症监护病房）。
我们在 RASP 期间进行的 360°重建是可行且安全的。该技术的目的是最大限度地减少电灼的使用，并减少前列腺包膜上的原始表面积。这种技术修改可能会减少 RASP 后的术后出血，因此可能不需要持续膀胱冲洗。此外，它可能有助于减轻术后灼热和刺激性症状。仍需要更长时间的随访和不同 RASP 技术的比较研究。
