Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
College of Medicine, Medical Research Center, Yeungnam University, Daegu, Korea.
J Robot Surg. 2024 May 8;18(1):205. doi: 10.1007/s11701-024-01950-6.
We aim to investigate the peri-operative outcomes after extraperitoneal single-port based robot-assisted radical prostatectomy (eSP-RARP) utilizing the da Vinci SP system compared to conventional transperitoneal multi-port counterparts (tMP-RARP), in an era when pelvic lymph node dissection (PNLD) was omitted for the node-negative case. With exclusion criteria of volume + 50 g, suspicious rectal invasion, and node-positive disease given relatively weak grasping power and limited range of motion from the current SP system, 50 consecutive patients (Since December 2021) with localized prostate cancer underwent eSP-RARP by a single urologist maintaining identical surgical technique for 100 consecutive tMP-RARP cases (Since December 2020). Given initial selection criteria, each group was matched to a 1:1 ratio based on the risk-stratification parameters and the prostate volume. The operative time, which was maintained in each group during the study period, was significantly faster in eSP-RARP groups than in tMP-RARP (149.2 vs. 163.2 min, p = 0.025), while the weight of the removed specimen (27.1 vs. 29.0 g, p = 0.420) and margin positivity (14.7% vs. 11.7% in pT2, p = 0.812) were similar. The gas-out (1.5 vs. 1.88 days, p = 0.003) and solid diet dates (2.26 vs. 3.22 days, p < 0.001) were faster in the eSP-RARP group. The single-pad continence dates (30.5 vs. 51.9 days, p = 0.145) and zero-pad continence dates (105.5 vs. 146.2 days, p = 0.210) were identical. 90-day single-pad continence rate was 92% vs. 82% (p = 0.142, 52% vs. 56% in zero-pad continence). Based on these, daVinci SP-based RARP restored bowel function faster with shorter operative time through an extraperitoneal approach than the conventional transperitoneal multi-port counterpart while maintaining similar incontinence outcomes in cases without a routine PNLD.
我们旨在研究在省略盆腔淋巴结清扫术 (PNLD) 用于淋巴结阴性病例的时代，经腹腔外单端口机器人辅助根治性前列腺切除术 (eSP-RARP) 与传统经腹腔多端口对照 (tMP-RARP) 的围手术期结局。鉴于当前 SP 系统相对较弱的抓握力和有限的运动范围，我们排除了体积 + 50 g、可疑直肠侵犯和淋巴结阳性疾病的病例。自 2021 年 12 月以来，50 例局限性前列腺癌患者 (50 例) 由同一位泌尿科医生进行 eSP-RARP，采用相同的手术技术，100 例连续 tMP-RARP 患者 (自 2020 年 12 月以来)。根据初始选择标准，每组根据风险分层参数和前列腺体积按 1:1 比例匹配。在研究期间，eSP-RARP 组的手术时间明显快于 tMP-RARP 组 (149.2 分钟对 163.2 分钟，p=0.025)，而切除标本的重量 (27.1 克对 29.0 克，p=0.420) 和切缘阳性率 (pT2 中 14.7%对 11.7%，p=0.812) 相似。eSP-RARP 组的气体排出时间 (1.5 天对 1.88 天，p=0.003) 和固体饮食时间 (2.26 天对 3.22 天，p<0.001) 更快。eSP-RARP 组的单垫控尿时间 (30.5 天对 51.9 天，p=0.145) 和零垫控尿时间 (105.5 天对 146.2 天，p=0.210) 相同。90 天单垫控尿率为 92%对 82% (p=0.142，零垫控尿率为 52%对 56%)。基于这些，达芬奇 SP 机器人辅助 RARP 通过经腹腔外途径恢复肠道功能更快，手术时间更短，而在不常规进行 PNLD 的情况下，保持相似的尿失禁结果。
