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三种单孔机器人辅助根治性前列腺切除术方法的比较:本机构的初步经验。

Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience.

机构信息

University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.

Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

出版信息

J Endourol. 2022 Dec;36(12):1551-1558. doi: 10.1089/end.2022.0330. Epub 2022 Sep 14.

Abstract

We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches-Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP)-performed at our institution using the da Vinci single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS ( = 32), EP ( = 30), and TP ( = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed  < 0.05 was considered significant. All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts ( < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 ± 40 minutes 248 ± 36 minutes,  < 0.001). Clinically significant margin rates did not differ significantly between cohorts ( = 0.861). Postoperative continence differed significantly between cohorts ( < 0.001); higher continence rates were observed in RS EP-94% (30/32) 52% (15/29), respectively,  < 0.001. Return of erectile function also differed significantly between cohorts ( = <0.001); higher erectile function recovery rates were observed in RS EP-88% (28/32) 41% (11/27), respectively,  < 0.001-and in RS TP-88% (28/32) 60% (22/37), respectively,  = 0.014. Median (IQR) follow-up time was 150 (88-377) days. RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.

摘要

我们旨在比较在我院使用达芬奇单端口(SP)平台(直觉外科公司,加利福尼亚州森尼韦尔)进行的三种机器人辅助根治性前列腺切除术(RARP)方法-保留耻骨后间隙(RS)、腹膜外(EP)和经腹腔(TP)。我们回顾性分析了在我院接受 SP-RARP 的 101 例患者的病历,并根据 RARP 方法将他们分为三组:RS(n=32)、EP(n=30)和 TP(n=39)。收集了术前患者特征、围手术期特征、肿瘤学结果和早期功能结果的数据。采用 Fisher 确切检验和卡方检验进行分类变量分析,采用 Kruskal-Wallis 检验进行数值变量分析。采用 Wilcoxon 秩和检验进行两两比较。双侧  < 0.05 被认为具有统计学意义。所有三组在术前患者特征方面基本相似。手术时间在组间存在显著差异( < 0.001),RS 组的平均手术时间快于 TP 组(208 ± 40 分钟 vs. 248 ± 36 分钟, < 0.001)。各组之间的临床显著切缘率无显著差异( = 0.861)。术后控尿情况在组间存在显著差异( < 0.001);RS 和 EP 组的控尿率分别为 94%(30/32)和 52%(15/29),差异有统计学意义( < 0.001)。勃起功能恢复情况在组间也存在显著差异( = <0.001);RS 和 EP 组的勃起功能恢复率分别为 88%(28/32)和 41%(11/27),差异有统计学意义( < 0.001),RS 和 TP 组的勃起功能恢复率分别为 88%(28/32)和 60%(22/37),差异有统计学意义( = 0.014)。中位(IQR)随访时间为 150(88-377)天。与 EP 和 TP 方法相比,RS SP-RARP 与改善的早期功能结果相关。这些获益是在保持等效肿瘤学结果的同时实现的。需要进一步的研究来优化 SP-RARP 方法的患者选择范式。

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