改良(免特殊PORT)单孔机器人辅助根治性前列腺切除术的初步经验

Modified single incision robot assisted laparoscopic radical prostatectomy:initial experience

目的:描述改良(免特殊 PORT)单孔机器人辅助根治性前列腺切除术手术通道建立的方法及技术路线,并分享前154例手术的临床初步经验。方法:回顾性分析2020年11月—2021年6月四川省人民医院机器人微创中心采用改良(免特殊PORT)单孔机器人辅助腹腔镜前列腺癌根治术治疗的154例前列腺癌患者的病例资料。患者平均年龄(66.7±7.3)岁,平均前列腺特异性抗原(PSA)(20.8±6.7)ng/mL,Gleason评分≤6分、7分、≥8分分别为52例(33.8%)、69例(44.8%)、33例(21.4%),前列腺体积48.4(25.0~200.0)mL,体重指数(BMI)≤25kg/m^(2)、>25kg/m^(2)分别为79例(51.3%)、75例(48.7%);临床分期:<cT_(3a)期149例,cT_(3a)期5例;既往有手术史36例。分享其手术通道的建立方法及技术路线,并观察手术相关指标、手术费用、术后并发症、病理及随访结果。结果:本研究154例手术均由同一名术者顺利完成。所有手术均采用改良(免特殊PORT)单孔方式。无中转开放或增加额外单孔通道器械。平均手术时间(61.8±13.7)min,平均术中出血量(72.2±15.3)mL,平均膀胱颈尿道吻合时间(11.7±3.6)min,平均术后住院时间(7.9±3.9)d,平均术后尿管留置时间(6.8±2.7)d,平均术后排气时间(1.1±0.2)d,平均切口长度(5.2±0.3)cm。无严重并发症。术后病理分期:<pT_(3a)期133例,≥pT_(3a)期21例;切缘阳性例数为27例(17.5%);术后1个月尿控满意患者135例(87.7%),每日使用尿垫≤1片/d。结论:改良(免特殊PORT)单孔机器人辅助根治性前列腺切除术安全可行,其具有术后恢复快、短期瘤控及尿控效果好、更好的美容效果、并较大幅度节约了手术费用、不受特定专用多通道腹腔镜入路装置限制、可复制性强等优势。但样本量较小,需进一步研究论证。

Objective:To describe the method and technical route of robot-assisted laparoscopic radical prostatectomy(RARP)via extraperitoneal PORT-free single incision approach,and share the preliminary clinical experience of the incipient 154operations.Methods:The data of 154patients with prostate cancer who underwent extraperitoneal PORT-free single incision RARP from November 2020to June 2021in Sichuan Provincial People's Hospital were retrospectively reviewed.Patients'average age was(66.7±7.3)years,their median PSA was(20.8±6.7)ng/mL;and the Gleason score≤6,7,≥8were 52(33.8%),69(44.8%),33(21.4%).The prostate volume was 48.4(25.0-200.0)mL;BMI≤25kg/m^(2),>25kg/m^(2) were 79cases(51.3%),75cases(48.7%).Clinical stage:149cases were in<cT_(3a),5case were in cT_(3a).Thirty-six cases had a history of operation.The surgical condition,postoperative complication,pathology,and follow-up results were observed.Results:In this study,154operations were successfully completed by the same operator without conversion to open or additional single hole channel instruments.All operations were performed by extraperitoneal PORT-free single-incision approach.The average operation time was(61.8±13.7)min,the mean intraoperative bleeding volume was(72.2±15.3)mL,the mean bladder neck urethral anastomosis time was(11.7±3.6)min,the mean postoperative hospital stay was(7.9±3.9)d,the mean postoperative indwelling time of urinary catheter was(6.8±2.7)d,and the mean postoperative evacuation time was(1.1±0.2)d.The average incision length was(5.2±0.3)cm.There was no obvious complications.The postoperative pathological stage:133cases were in<pT_(3a),21cases were in≥pT_(3a),and 27cases(17.5%)had positive resection margin.One hundred and thirty-five cases(87.7%)acquired satisfactory urinary continence after operation,and the frequency of urinary pad use was≤1tablet/day.Conclusion:The extraperitoneal PORT-free single-incision RARP is safe and feasible with a satisfying cosmetic effect,and it saves costs and requires specific less channel device.Moreover,this new approach has high replicability,short-term tumor control and urinary control effect with rapid postoperative recovery.However,the sample size of this study is relatively small,so further research and demonstration were needed.