Quarrier Scott O, Matloubieh Jubin E, Wu Guan
Department of Urology, University of Rochester Medical Center, Rochester, NY.
Department of Urology, University of Rochester Medical Center, Rochester, NY.
Urology. 2019 Feb;124:292-296. doi: 10.1016/j.urology.2018.09.027. Epub 2018 Oct 29.
To present a robot-assisted surgical technique for overcoming challenges of a patient with prior pelvic surgeries and bowel in the radiation target.
A 72-year-old male required treatment for biochemically recurrent prostate cancer. In 2006, he presented with Prostate-Specific Antigen (PSA) 5.74 ng/mL, Gleason 3 + 3 prostate cancer. He underwent a robot-assisted radical prostatectomy for pT2aNx adenocarcinoma with negative margins. In 2008, he was found to have muscle-invasive high-grade papillary urothelial carcinoma and underwent robot-assisted radical cystectomy and ileal conduit for pT2bN0 urothelial carcinoma. In 2017, he had prostate cancer biochemical recurrence, with a PSA of 0.27 ng/mL. Pelvic CT showed small bowel in his prostatic bed behind the pubic bone. A robot-assisted lysis of adhesions and placement of a tissue expander in the prostatic fossa was performed. Three robotic ports and 1 assistant port were utilized. The sigmoid and small bowel were displaced during lysis of adhesions. The deflated tissue expander was inserted through the midline trocar site, inflated intra-abdominally, and filled with 330 cc of saline. The tissue expander was secured with proline sutures in a dependent position. The patient subsequently underwent Intensity-modulated radiation therapy of 66 Gy to the prostatic fossa. Eleven days after finishing intensity-modulated radiation therapy, he underwent successful laparoscopic removal of the tissue expander. PSA nadir was <0.02 ng/mL.
The patient tolerated intensity-modulated radiation therapy without complications. There were no gastrointestinal complaints following radiation therapy.
Robotic placement of a tissue expander in patients who have undergone multiple pelvic surgeries is feasible and may reduce radiation morbidity.
介绍一种机器人辅助手术技术，以应对曾接受盆腔手术且肠道位于放疗靶区内的患者所面临的挑战。
一名72岁男性因生化复发的前列腺癌需要治疗。2006年，他的前列腺特异性抗原（PSA）为5.74 ng/mL，Gleason评分3+3前列腺癌。他接受了机器人辅助根治性前列腺切除术，治疗pT2aNx腺癌，切缘阴性。2008年，他被诊断为肌肉浸润性高级别乳头状尿路上皮癌，并接受了机器人辅助根治性膀胱切除术和回肠导管术，治疗pT2bN0尿路上皮癌。2017年，他出现前列腺癌生化复发，PSA为0.27 ng/mL。盆腔CT显示耻骨后方前列腺床内有小肠。进行了机器人辅助粘连松解术，并在前列腺窝内放置了组织扩张器。使用了三个机器人端口和一个辅助端口。粘连松解过程中推移了乙状结肠和小肠。将未充气的组织扩张器通过中线套管针部位插入，在腹腔内充气，并注入330 cc生理盐水。用脯氨酸缝线将组织扩张器固定在下垂位置。患者随后接受了前列腺窝66 Gy的调强放射治疗。调强放射治疗结束11天后，他成功接受了腹腔镜下组织扩张器取出术。PSA最低点<0.02 ng/mL。
患者耐受调强放射治疗，无并发症。放射治疗后无胃肠道不适。
对于接受过多次盆腔手术的患者，机器人辅助放置组织扩张器是可行的，且可能降低放疗并发症发生率。
