Kanao Kent, Muramatsu Hiroyuki, Morinaga Shingo, Kobayashi Ikuo, Kajikawa Keishi, Nishikawa Genya, Watanabe Masahito, Nakamura Kogenta
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Department of Urology, Aichi Medical University, Nagakute, Japan.
J Endourol Case Rep. 2020 Sep 17;6(3):220-223. doi: 10.1089/cren.2020.0021. eCollection 2020.
Recently, two techniques of robot-assisted radical prostatectomy (RARP), which preserve dorsal vein complex (DVC), endopelvic fascia, and full neurovascular bundle (NVB), through anterior approach were reported. The techniques in a relatively large workspace seem less technically demanding than Retzius-sparing RARP. In this case report, we present a further modified technique of transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia to reduce the technical demands. In a routine evaluation, a 65-year-old man was shown to have a prostate-specific antigen level of 5.07 ng/mL. Prostatic biopsy revealed a Gleason score of 6 (3 + 3) adenocarcinoma in 2 of the 12 specimens, and the clinical stage was diagnosed as cT2aN0M0. RARP was performed including transperitoneal full NVB sparing, antegrade preservation of DVC, and division of endopelvic fascia to increase the prostate mobility and reduce technical demands. The patient completely gained continence on the day after removal of the catheter, and potency was recovered 30 days after surgery. Our DVC preservation technique in the transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia during RARP may be safe, reduce technical demands, and facilitate early recovery of continence and sexual function after surgery.
最近，有报道称两种经前路保留背静脉复合体（DVC）、盆内筋膜和完整神经血管束（NVB）的机器人辅助根治性前列腺切除术（RARP）技术。在相对较大的操作空间中，这些技术似乎比保留Retzius间隙的RARP技术要求更低。在本病例报告中，我们介绍了一种经腹-前路-顺行入路的进一步改良技术，通过切开盆内筋膜来降低技术要求。在常规评估中，一名65岁男性的前列腺特异性抗原水平为5.07 ng/mL。前列腺活检显示，12个标本中有2个的Gleason评分为6（3+3）腺癌，临床分期诊断为cT2aN0M0。实施了RARP，包括经腹保留完整的NVB、顺行保留DVC以及切开盆内筋膜以增加前列腺的活动度并降低技术要求。患者在拔除导尿管后的第二天完全恢复了控尿能力，术后30天恢复了性功能。我们在RARP中采用经腹-前路-顺行入路并切开盆内筋膜的DVC保留技术可能是安全的，可降低技术要求，并有助于术后控尿和性功能的早期恢复。
