Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urology. 2020 Jul;141:173-177. doi: 10.1016/j.urology.2020.02.024. Epub 2020 Mar 11.
To present our initial experience with single-port percutaneous transvesical simple prostatectomy using the novel SP robotic surgical system.
Ten patients underwent single-port transvesical simple prostatectomy between February and November 2019. Percutaneous access to the bladder dome was made and all SP instruments were inserted through the SP multichannel cannula directly into the bladder. Prostate adenoma enucleation, hemostasis and trigonization were done according to the principles of open simple prostatectomy technique. Demographics and perioperative outcomes were prospectively collected and analyzed.
All procedures were performed successfully without the need for conversion to open surgery. Median preoperative estimated prostate size was 159 (Interquartile range (IQR) 108-223) grams. No intraoperative complications occurred. Median operative time and estimated blood loss were 190 (IQR 146-203) minutes and 100 (IQR 68-175) ml, respectively. Mean postoperative specimen weight was 84.3 ± 34 grams. Median length of hospital stay was 19 (IQR 17-28) hours. All patients were satisfied with their urinary flow after catheter removal without any episode of acute urinary retention 1-6 months, postoperatively.
Single-port transvesical simple prostatectomy can be offered as an alternative treatment option for surgical management of lower urinary tract symptoms associated with large prostate adenoma. Sparing the peritoneal cavity, minimum dissection of the bladder, excellent visualization of the prostate fossa can be some of the potential advantages of this minimally invasive approach. Comparative studies with standard techniques are advisable to evaluate the surgical outcome and postoperative morbidity of each treatment modality.
介绍我们使用新型 SP 机器人手术系统进行经单一通道经膀胱前列腺单纯切除术的初步经验。
2019 年 2 月至 11 月期间，10 例患者接受了单通道经膀胱前列腺单纯切除术。经膀胱顶皮穿刺入路，所有 SP 器械通过 SP 多通道套管直接插入膀胱。根据开放性前列腺单纯切除术技术的原则进行前列腺腺瘤剜除、止血和三角化。前瞻性收集和分析人口统计学和围手术期结果。
所有手术均成功完成，无需转为开放性手术。术前平均估计前列腺大小为 159 克（四分位距 (IQR) 108-223）。术中无并发症发生。平均手术时间和估计失血量分别为 190 分钟（IQR 146-203）和 100 毫升（IQR 68-175）。术后标本平均重量为 84.3±34 克。平均住院时间为 19 小时（IQR 17-28）。所有患者在术后 1-6 个月拔除导尿管后均对尿流感到满意，无急性尿潴留发生。
对于大前列腺腺瘤相关下尿路症状的手术治疗，经单一通道经膀胱前列腺单纯切除术可作为一种替代治疗选择。避免了腹膜腔，膀胱最小程度的解剖，前列腺窝的良好可视化可能是这种微创方法的一些潜在优势。与标准技术的比较研究是评估每种治疗方式的手术结果和术后发病率的明智选择。
