Department of Surgery, Severance Hospital, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2020 Apr;30(2):137-143. doi: 10.1097/SLE.0000000000000779.
Robotic surgery can help to identify and preserve the autonomic nerves during total mesorectal excision (TME) compared with open surgery or laparoscopy due to the 3-dimensional image and high dexterity of the robotic system. Therefore, this study aimed to assess voiding and sexual function after robotic TME with autonomic nerve preservation. In particular, we focused on the long-term results in male patients operated by a single experienced surgeon.
We surveyed male patients aged 50 years and below at the time of robotic rectal cancer surgery between November 2011 and July 2018. Patients who died and those who had a recurrence and underwent abdominoperineal resection were excluded. The questionnaire covered the International Prostate Symptom Score (IPSS) and the 5-item version of the International Index of Erectile Function (IIEF-5) for voiding and sexual function, respectively.
Thirty-nine patients (median age, 44 y) were surveyed. IPSS and IIEF-5 scores were 5.7±5.3 and 14.7±8.4, respectively. Only 6 patients (15.4%) complained of poor quality of life due to their urinary symptoms. In sexual function, 10 patients (25.6%) complained severe reduction compared with their preoperative status. The average of postoperative days defined from surgery to the questionnaire was 37.8 months. A significant change in the IIEF-5 score was observed between 1 and 2 years postoperatively (5.8±6.9 vs. 16.5±8.8; P=0.027).
As we only included male patients who were operated by a single experienced surgeon, the results of robotic TME with pelvic autonomic nerve preservation showed acceptable data in preserving both voiding and sexual functions. Although related clinical factors for poor functional outcomes was not statistically significant due to the small sample size, we could observe an improvement in sexual function between 1 and 2 years after surgery with long-term functional results.
与开放手术或腹腔镜相比，机器人手术由于其 3D 图像和机器人系统的高灵活性，可以帮助在全直肠系膜切除术中（TME）识别和保留自主神经。因此，本研究旨在评估保留自主神经的机器人 TME 后的排尿和性功能。特别是，我们关注的是由一位经验丰富的外科医生为男性患者进行的长期结果。
我们调查了 2011 年 11 月至 2018 年 7 月期间接受机器人直肠肿瘤手术的 50 岁及以下的男性患者。排除死亡和复发并接受腹会阴切除术的患者。问卷涵盖了排尿功能的国际前列腺症状评分（IPSS）和 5 项国际勃起功能指数（IIEF-5），分别用于评估性功能。
调查了 39 名患者（中位年龄 44 岁）。IPSS 和 IIEF-5 评分分别为 5.7±5.3 和 14.7±8.4。只有 6 名患者（15.4%）因排尿症状而抱怨生活质量差。在性功能方面，10 名患者（25.6%）抱怨与术前相比严重下降。从手术到问卷调查的术后天数平均为 37.8 个月。术后 1 至 2 年 IIEF-5 评分有显著变化（5.8±6.9 比 16.5±8.8；P=0.027）。
由于我们只包括由一位经验丰富的外科医生为男性患者进行手术，因此保留盆腔自主神经的机器人 TME 的结果在保留排尿和性功能方面显示出可接受的数据。尽管由于样本量小，与功能结果不佳相关的临床因素没有统计学意义，但我们可以观察到手术后 1 至 2 年内性功能有所改善，并具有长期的功能结果。
