Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland OH, USA.
Chinese University of Hong Kong and Division of Urology at Prince of Wales Hospital, Shatin, Hong Kong.
Int Braz J Urol. 2019 Jul-Aug;45(4):854-855. doi: 10.1590/S1677-5538.IBJU.2018.0524.
To report the technique for single-port trans-perineal cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection using a purpose-built robotic platform (da Vinci SP1098, Intuitive Surgical, Sunnyvale, CA, USA).
In a male cadaver the SP1098 robotic system was used to perform cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection by single-port trans-perineal approach. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12 x 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm accessory laparoscopic instrument were positioned. At the planned level of the stoma for the ileal conduit, a 12-mm port was placed through which the EndoGIA® stapler was used to mature the urinary diversion Results: The total operative time was 185 min. The procedure was successfully completed without the need for additional ports placement. The benefits of the trans-perineal approach, particularly in longer procedures as radical cystectomy with intracorporeal urinary diversion, might include the avoided need of Trendelenburg position, with undoubtful advantages for the patient and the anesthesiologist in terms of respiratory mechanics and hemodynamics.
The feasibility of single-port trans-perineal cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection using the SP1098 purpose-built robotic platform is demonstrated. The duplication of the described surgical steps in the clinical model is awaited when the platform will be available on the market.
报告使用专用机器人平台（达芬奇 SP1098，直观外科，加利福尼亚州桑尼维尔）经单孔经会阴行根治性膀胱前列腺切除术联合体内回肠导管尿流改道术和淋巴结清扫术的技术。
在一名男性尸体中，使用 SP1098 机器人系统经单孔经会阴入路行根治性膀胱前列腺切除术联合体内回肠导管尿流改道术和淋巴结清扫术。手术通过会阴 2.5cm 切口完成，通过该切口置入 GelPOINT Mini 高级通道平台（Applied Medical，加利福尼亚州拉古纳圣玛格丽塔）和专用 25mm 多通道端口，该端口可容纳 12x10mm 椭圆形关节式机器人摄像头、三个 6mm 双关节关节式机器人器械和一个 6mm 辅助腹腔镜器械。在计划的回肠导管造口水平放置 12mm 端口，通过该端口使用 EndoGIA®吻合器使尿流改道成熟。
总手术时间为 185 分钟。无需额外放置端口即可成功完成该手术。经会阴入路的优点，特别是在根治性膀胱切除术联合体内尿流改道术等较长手术中，可能包括避免使用特伦德伦堡体位，这对患者和麻醉师在呼吸力学和血液动力学方面无疑具有优势。
使用 SP1098 专用机器人平台经单孔经会阴行根治性膀胱前列腺切除术联合体内回肠导管尿流改道术和淋巴结清扫术的可行性已得到证实。当该平台上市时，将等待在临床模型中复制描述的手术步骤。
