逆行松解神经血管束且保留Retzius间隙机器人辅助腹腔镜根治性前列腺切除术的技术要点(“大家泌尿网”观看手术视频)

Technical points of Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

保留耻骨后间隙的前列腺癌根治术(RS-RARP)可以显著提高术后即刻尿控且不增加切缘阳性率。然而该术式学习曲线长,目前能掌握的学者不到10%,尚未推广。基于对前列腺解剖结构及手术方式的认识,本中心对RS-RARP进行优化。我们首创了完全后入路逆行松解神经血管束的RARP,最大限度保留神经血管束,简化手术操作,仅使用一根缝线即可完成尿道吻合,无需使用Hem-o-lok,减少相关并发症。我们在本中心常规开展该术式,通过多维度分析认为这是一种“肿瘤控制可、尿控保护好、性功能恢复快、并发症少、可操作性强”的手术方式。本文详细介绍该术式的关键步骤及操作体会。

Retzius-sparing robot assisted radical prostatectomy(RS-RARP)can significantly improve the immediate urinary continence without increasing the positive rate of surgical margin.However,the learning curve is long,and fewer than 10%of the surgeons can master it.Therefore,we have optimized the procedures of RS-RARP,applying radical prostatectomy with retrograde release of neurovascular bundle to preserve it to the maximum extent.Urethral anastomosis can be performed with only one suture,which eliminates the need for Hem-o-lok and reduces subsequent complications.Our team routinely carries out this operation,and conlcudes that this surgical method can achieve good tumor control,good urinary continence,fast recovery of sexual function,few complications,and strong operability.This article details the key steps and operation experience of this technique.