Outcomes after robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

Cavernous Nerve Graft Reconstruction with a Novel Artificial Conduit during Robot-Assisted Laparoscopic Radical Prostatectomy

The interposition sural nerve graft has been attempted occasionally during radical prostatectomy for the recovery of continence and erectile function;however, nerve autograft may result in adverse events for the patient. Here, we present our initial experiences using NerbridgeTM, a novel conduit for peripheral nerve regeneration, rather than utilizing sural nerve grafting, in robot-assisted laparoscopic radical prostatectomy to overcome autograft problems such as prolongation of operation time and postoperative abnormal sensation. This novel artificial conduit interposition can be technically feasible when combined with robotic surgery, and prospective randomized controlled trials with high patients-numbers and long follow-up periods are warranted.

Comparison of the effects of deep and moderate neuromuscular block on respiratory system compliance and surgical space conditions during robot-assisted laparoscopic radical prostatectomy: a randomized clinical study

Objective:Robot-assisted radical prostatectomy(RARP)requires pneumoperitoneum(Pnp)and a steep head-down position that may disturb respiratory system compliance(Crs)during surgery.Our aim was to compare the effects of different degrees of neuromuscular block(NMB)on Crs with the same Pnp pressure during RARP.Methods:One hundred patients who underwent RARP were enrolled and randomly allocated to a deep or moderate NMB group with 50 patients in each group.Rocuronium was administered to both groups:in the moderate NMB group to maintain 1–2 responses to train-of-four(TOF)stimulation;and in the deep NMB group to maintain no response to TOF stimulation and 1–2 responses in the post-tetanic count.Pnp pressure in both groups was 10 mm Hg(1 mm Hg=133.3 Pa).Peak inspiratory pressure(Ppeak),mean pressure(Pmean),Crs,and airway resistance(Raw)were recorded after anesthesia induction and at 0,30,60,and 90 min of Pnp and post-Pnp.Surgical space conditions were evaluated after the procedure on a 4-point scale.Results:Immediately after the Pnp,Ppeak,Pmean,and Raw significantly increased,while Crs decreased and persisted during Pnp in both groups.The results did not significantly differ between the two groups at any of the time points.There was no difference in surgical space conditions between groups.Body movements occurred in 14 cases in the moderate NMB group and in one case in the deep NMB group,and all occurred during obturator lymphadenectomy.A significant difference between the two groups was observed.Conclusions:Under the same Pnp pressure in RARP,deep and moderate NMBs resulted in similar changes in Crs,and in other respiratory mechanics and surgical space conditions.However,deep NMB significantly reduced body movements during surgery.

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy:A single center analysis

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

Hem-o-lok-free and Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

Background:Robot-assisted laparoscopic radical prostatectomy(RARP)has gradually become the standard surgical procedure for prostate cancer.This video,aimed to demonstrate a new and improved surgical approach for prostate cancerthat passes through the pouch of Douglas and allows retrograde release of the neurovascular bundle(NVB).The technique is Hem-o-lok-free and Retzius-sparing and is performed without opening the pelvic floor fascia during RARP.Methods:A 69-year-old man was diagnosed with prostate cancer(clinical stage T2bN0M0).We followed the process of Retzius-sparing RARP[published by Galfano et al.in 2013]and did some modification.The critical technical points associated with this technique included locating the fascial layer at the prostatic apex and performing complete retrograde release of the NVB along the anatomical structure.We used diathermy to perform precision hemostasis on large vessels,especially those around the basal part of prostate,with relatively less damage.In addition,Hem-o-lok was not used in this procedure.Results:Negative surgical margin and stage T2bN0M0 were confirmed.Continence was achieved immediately after catheter removal.One month after surgery,prostate specific antigen was undetectable.Erectile function was preserved 3 months postoperatively.Conclusions:Hem-o-lok-free and Retzius-sparing RARP is a feasible surgical approach that combines the benefits of complete retrograde release of the NVB,preserving the nerves and vascular structures around the prostate,protecting the pelvic floor structure,and ensuring rapid recovery of micturition control.

A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.

The current status of robot-assisted radical prostatectomy

Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.

Single-centre study comparing standard apical dissection with a modified technique to facilitate vesico-urethral anastomosis during laparoscopic radical prostatectomy

A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis （VUA） in laparoscopic radical prostatectomy （LRP） was reported. A total of 42 patients were randomly selected and enrolled in this study. A standard LRP was performed in 21 patients （group 1）, whereas a novel, modified apical dissection of the prostate in LRP was performed in another 21 patients （group 2）. Surgical data, total operative time, VUA time, extravasation rate, catheterisation time, occurrence of anastomotic strictures, and the early and late continence rates were analysed statistically. No differences in clinical or pathological characteristics were determined between the two groups. The total operative time, VUA time, blood loss and catheterisation time were lower in group 2, which received the novel, modified technique compared with group 1, which received the standard technique to dissect the apex of the prostate （P〈0.01 for each variable）. Regarding the extravasation rate and the occurrence of anastomotic strictures, no significant differences were found between the two groups （P〉0.0.05 for each）. After catheter removal, a statistically significant difference in the continence rates was present at 3 and 30 days post operation in the two groups （P〈0.01, respectively）. At 90 days post operation, the difference, although still present, was no longer statistically significant （P〉0.05）. The novel, modified apical dissection of the prostate facilitates the VUA and significantly improves the efficacy of the procedure and early restoration of continence.

Nerve-sparing robot-assisted radical prostatectomy:Current perspectives

Robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined disease.The introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes.This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes,the neurovascular bundle(NVB),various NS techniques and postoperative functional outcomes.A non-systematic review was done using PubMed,Embase and Medline databases to retrieve and analyse articles in English,with following keywords“prostate cancer”,“robotic radical prostatectomy”,“nerve-sparing”.The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies.The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other.Variables such as preoperative risk assessments,baseline potency,surgical anatomy of individual patients and surgeons’expertise play a major role in the outcomes.A tailored approach for each patient is required for applying the NS approach during RARP.

Significance of preoperatively observed detrusor overactivity as a predictor of continence status early after robot-assisted radical prostatectomy

Several recent studies have reported the involvement of bladder dysfunction in the delayed recovery of urinary continence following radical prostatectomy （RP）. The objective of this study was to investigate the significance of detrusor overactivity （DO） as a predictor of the early continence status following robot-assisted RP （RARP）. This study included 84 consecutive patients with prostate cancer undergoing RARP. Urodynamic studies, including filling cystometry, pressure flow study, electromyogram of the external urethral sphincter and urethral pressure profile, were performed in these patients before surgery. Urinary continence was defined as the use of either no or one pad per day as a precaution only. DO was preoperatively observed in 30 patients （35.7%）, and 55 （65.5%） and 34 （40.5%） were judged to be incontinent 1 and 3 months after RARP, respectively. At both 1 and 3 months after RARP, the incidences of incontinence in patients with DO were significantly higher than in those without DO. Of several demographic and urodynamic parameters, univariate analyses identified DO and maximal urethral closure pressure （MUCP） as significant predictors of the continence status at both 1 and 3 months after RARP. Furthermore, DO and MUCP appeared to be independently associated with the continence at both I and 3 months after RARP on multivariate analysis. These findings suggest that preoperatively observed DO could be a significant predictor of urinary incontinence early after RARP; therefore, it is recommended to perform urodynamic studies for patients who are scheduled to undergo RARP in order to comprehensively evaluate their preoperative vesicourethral functions.

Modified transperitoneal laparoscopic radical prostatectomy:technique and clinical outcomes

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with ages ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg /L and

Impact of postoperative sexual function on health-related quality of life after robot-assisted radical prostatectomy

Background:We investigated potential disparities in health-related quality of life,particularly concerning urinary function,between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy(RARP).Materials and methods:BetweenDecember 2012 and April 2020,704men underwent RARP in our hospital.This study included 155 patients with a preoperative 5-item International Index of Erectile Function(IIEF-5)of≥12 points and an assessable IIEF-5 at 12 months postoperatively.Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite(EPIC)preoperatively and at 3,6,and 12months postoperatively.A logistic regression analysis andWilcoxon rank sum tests were performed.Results:Patients were grouped according to the median IIEF-5 score 12 months after surgery:those with preserved sexual function(n=71)and those with impaired sexual function(n=84).The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function(p<0.01).In the EPIC,the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points comparedwith the groupwith impaired sexual function(p<0.01).In the comparison of the urinary subdomains of the EPIC,there were no significant differences in urinary function or incontinence,but there were significant differences in urinary distress and irritative/obstructive scores(p<0.01).Conclusions:Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function.Hence,preserved sexual function is closely associated with urinary function.

Peritoneal interposition flap reduces symptomatic lymphocele following transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection:An updated meta-analysis

Background Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate-and high-risk prostate cancer.However,this method is associated with symptomatic lymphocele(SLC),which is an important morbidity factor.To overcome this complication,several modifications of the technique have been developed,including the peritoneal interposition flap(PIF).We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele(LC)formation.Materials and methods Searches were performed using databases and references from included studies and previous systematic reviews.Only randomized controlled trials and nonrandomized cohorts were included.Primary outcomes were the incidence of SLC and LC formation,and safety outcomes were defined as operation time,estimated blood loss,length of hospital stay,and urinary incontinence.Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool.Pooled treatment effects were estimated using odds ratios with 95%confidence intervals(CIs)for binary endpoints.Heterogeneity was examined using Cochran's Q test and I2 statistics;p values<0.10 and I2>25%were considered significant for heterogeneity.We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity.Otherwise,the DerSimonian and Laird random-effects model was used.Results The initial search yielded 510 results.After the removal of duplicate records and application of the exclusion criterion,9 studies were fully reviewed for eligibility.Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria,comprising 2261 patients,of whom 1073(47.4%)underwent PIF.Six studies reported a significant reduction in SLC in the PIF group,and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication.The incidence of SLC and LC formation in a follow-up of≥3 months was significantly different between the PIF and no PIF group(odds ratio,0.34[95%CI,0.16–0.74;p=0.006]and 0.48[95%CI,0.31–0.74;p=0.0008]),respectively.The safety outcomes did not differ significantly between the 2 groups.Conclusions These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.

Proficiency score as a predictor of early trifecta achievement during the learning curve of robot-assisted radical prostatectomy for high-risk prostate cancer:Results of a multicentric series

Background:Recently,an innovative tool called“proficiency score”was introduced to assess the learning curve for robot-assisted radical prostatectomy(RARP).However,the initial study only focused on patients with low-risk prostate cancer forwhompelvic lymph node dissection(PLND)was not required.To address this issue,we aimed to validate proficiency scores of a contemporarymulticenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.Material andmethods:Between 2010 and 2020,4 Italian institutional prostate-cancer datasets weremerged and queried for“RARP”and“high-risk prostate cancer.”High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows:prostate-specific antigen>20 ng/mL,International Society ofUrological Pathology≥4,and/or clinical stage(cT)≥2c on preoperative imaging.The selected cohort(n=144)included clinical cases performed by trainee surgeons(n=4)after completing their RARP learning curve(50 procedures for low-risk prostate cancer).The outcome of interest,the proficiency score,was defined as the coexistence of all the following criteria:a comparable operation time to the interquartile range of the mentor surgeon at each center,absence of any significant perioperative complications Clavien-Dindo Grade 3–5,no perioperative blood transfusions,and negative surgical margins.A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort.For all statistical analyses,a 2-sided p<0.05 was considered significant.Results:A proficiency score was achieved in 42.3%patients.At univariable level,proficiency score was associated with 1-year trifecta achievement(odds ratio,8.77;95%confidence interval,2.42–31.7;p=0.001).After multivariable adjustments for age,nerve-sparing,and surgical technique,the proficiency score independently predicted 1-year trifecta achievement(odds ratio,9.58;95%confidence interval,1.83–50.1;p=0.007).Conclusions:Our findings support the use of proficiency scores in patients and require extended PLND in addition to RARP.

Prognostic value of Controlling Nutritional Status score for postoperative complications and biochemical recurrence in prostate cancer patients undergoing laparoscopic radical prostatectomy

Background:Controlling Nutritional Status(CONUT)score was used for screening the preoperative nutritional status.The correlation between the CONUT score and the prognosis of patients with prostate cancer(PCa)has yet to be elucidated.Herein,we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy.Materials and methods:Data of 244 patients were retrospectively evaluated.Perioperative variables and follow-up data were analyzed.The patients were categorized into 2 groups according to their preoperative CONUT scores.Postoperative complication and incontinence rates were also compared.The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival(BCRFS)between the 2 groups.Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS.Results:Patients were categorized into the low-CONUT group(CONUT score<3,n=207)and high-CONUT group(CONUT score≥3,n=37).The high-CONUT group had a higher overall complication rate(40.5%vs.19.3%,p=0.004),a higher major complication rate(10.8%vs.3.9%,p=0.013),and longer postoperative length of stay(8 days vs.7 days,p=0.017).More fever,urinary infection,abdominal infection,scrotal edema,rash,and hemorrhagic events(all p values<0.05)were observed in the high-CONUT group.A higher rate of urinary incontinence was observed in the high-CONUT group at 1(34.4%vs.13.2%,p=0.030)and 3 months(24.1%vs.8.2%,p=0.023)postoperatively.The high-CONUT group had shorter medium BCRFS(23.8 months vs.54.6 months,p=0.029),and a CONUT score≥3 was an independent risk factor for a shorter BCRFS(hazards ratio,1.842;p=0.026).Conclusions:The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.

Surgical approach affecting long-term urinary continence status after robot-assisted laparoscopic prostatectomy prospectively evaluated using self-reported functional status(Expanded Prostate Cancer Index Composite,EPIC-26)

Purpose:The aim of the study was to examine the influence of the surgical approach for robot-assisted laparoscopic prostatectomy(RALP)on long-term urinary continence status in the era of self-reported functional status measures using the Expanded Prostate Cancer Index Composite 26.Materials and methods:This is a prospective evaluation of 232 patients undergoing RALP between September,2019 and September,2020.Urinary continence status and postoperative incontinence(pad usage)were evaluated 12 months after RALP using Expanded Prostate Cancer Index Composite 26 questionnaires.Patients were categorized according to their surgical approach and outcome into the following groups:successful nerve sparing(NS),primarily without nerve sparing(prim.NNS),and no nerve sparing by secondary resection(NNS by SR).The median levels of their questionnaire outcomes were evaluated and compared using the Wilcoxon rank sum test with continuity correction.Results:Urinary continence status 12 months after RALP differed significantly between the NS and prim.NNS(p=0.0071)and the NS and NNS by SR(p=0.0076)groups.There was no significant difference between the prim.NNS and NNS by SR(p=0.53)groups.Pad usage 12 months after RALP had no significant difference with regard to SR of the neurovascular bundle(p=0.14).Conclusions:Patient-reported outcomes of long-term urinary continence status seem to show no difference in postoperative continence,regardless of whether a non-nerve-sparing result was planned or reached through SR.Instead,preservation of neurovascular bundle seems to lead to better long-term continence rates.

Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system:A retrospective study based on a tertiary hospital database in China

ObjectiveThis study aimed to demonstrate a new surgical shear with an integrated energy system(Harmonic ACE^(®)+7)value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears(CUSs)in a real-world setting.MethodsThis was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE^(®)+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital(the headquarters and Luwan Center in China).Demographic and diagnosis information,intraoperative and postoperative clinical outcomes,and total and categorical costs were collected.Propensity score matching was performed to form the study population for each clinical group.Data were compared between the two groups using t-test and Chi-squared test.ResultsThe ACE^(®)+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs(12.8 vs.19.8,p<0.001),a moderate but not significant difference in mean postoperative drainage duration(6.6[standard deviation,SD 2.2]days vs.7.9[SD 4.1]days,p=0.082),a reduction on mean total drainage volume(275.5[SD 374.3] mL vs.492.9[SD 1495.0]mL,p=0.321),and a lower mean rate of postoperative hemostatic drug usage(16.0%vs.52.0%,p<0.001).There was no significant difference in total costs between the ACE^(®)+7 and CUS groups.ConclusionThis study provides real-world data demonstrating that the ACE^(®)+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems.Using the ACE^(®)+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.

The Diagnosis and Treatments of Inguinal Hernia after Radical Prostatectomy

Prostate cancer (PC) is one of the most common causes of cancer-related death in the world among old men. Radical prostatectomy (RP) is the most common surgical procedure in treatments. However, the complications after RRP always confuse surgeons. Urinary incontinence, impotence, erectile dysfunction frequently have effects on the quality of life after RP on patients occurred PC. Inguinal hernias (IHs) after RP is the most common complication, especially indirect hernias. Thus, patients occurred post-IH are frequently performed secondary surgery. In recent years, urologists have explored different surgical techniques, managements, and preoperationly detections to prevent the development of IH postoperationly. However, the precise mechanism of this procedure occurred is unclear till now. Some retrospective studies have been performed to explore the occurence of IH post-RRP and prophylactic techniques to prevent or decrease IH occurred after RRP. Disappointingly, there is no one efficient and precise method influenced this procedure occurred. We reviewed recent studies about IH after RP through different approaches to evaluate the development of this procedure.

Effects of dexmedetomidine combined with dezocine on tumor factors, immune function levels and related serum factors in patients with laparoscopic surgery for ovarian cancer

Objective:To study the effects of dexmedetomidine combined with dezocine on tumor factors, immune function levels and related serum factors in patients with laparoscopic surgery for ovarian cancer.Methods: To select 120 cases of laparoscopic ovarian cancer treated and planned to undergo laparoscopic radical operation in our hospital were randomly and equally divided into control group and treatment group. The patients in control group were treated with dezocine, the treatment group were treated with dexmedetomidine combined with dezocine. To detect and compare the serum HE4, YKL-40, TSGF, NSE, S100β protein, MDA, SOD and peripheral blood CD3+, CD4+, CD8+ and calculate CD4+/CD8+ before and after operation. Results: Before the surgery, there was no significant difference in serum HE4, YKL-40, TSGF, NSE, S100β protein, MDA and SOD between the two groups(P>0.05). After surgery, there were significant differences between the two groups in serum HE4, YKL-40, TSGF, NSE, S100β protein, MDA and SOD levels and the same group before surgery (P<0.05), the improvement of each index in the treatment group was better than those in the control group, and the differences were significantly (P<0.05). Before the surgery, the differences between the two groups in peripheral blood CD3+, CD4+, CD8+ and CD4+/CD8+ had no significant difference (P>0.05), After surgery, the differences between the two groups and the same group before operation in peripheral blood CD3+, CD4+, CD8+ levels and CD4+/CD8+ were significantly (P<0.05), the improvement of each index in the treatment group was better than that in the control group, the differences were significantly (P<0.05).Conclusion:Dexmedetomidine combined with dezocine can reduce the serum HE4, YKL-40, TSGF, NSE, S100β protein levels in patients with ovarian cancer after laparoscopic operation, reduce the oxidative stress reaction, has smaller effect on cellular immune function.

术前MRI参数对腹腔镜根治性前列腺切除术术后早期尿控的预测

目的:收集术前核磁共振成像(MRI)所得图像测量的尿路结构相关参数,探究其与腹腔镜根治性前列腺切除术(LRP)术后早期尿控的关联性,为术后发生尿失禁的高危人群筛选提供理论依据。方法:经严格的筛选后共纳入自2015年1月至2021年2月在首都医科大学附属北京同仁医院确诊为前列腺癌并行LRP的49例患者,患者年龄50~78岁,随访时间1年。术前通过收集患者完整资料,提取可能与术后早期尿控情况相关的临床数据,同时测量MRI图像所示可能与尿控相关的解剖结构参数,并收集术后早期患者尿控恢复情况的相关数据—尿垫使用数量。采用SPSS23.0对数据进行基础统计学分析,经单因素相关分析筛选可能相关因素(P<0.1),再采用R4.0.3或SPSS23.0对纳入的因素与尿控结果进行多因素Logistic回归分析。结果:MRI图像测量所得前列腺前后径长度为(4.0±1.11)cm;前列腺左右径长度为(4.6±0.83)cm;前列腺上下径长度为2.4~6.4 cm;膜部尿道长度(MUL)为(13.16±3.52)mm;尿道横纹括约肌厚度范围为1.08~4.37 mm。多因素分析结果显示年龄与术后1个月尿控是否恢复存在相关性(P=0.035,OR=0.16)。尿道横纹肌厚度与术后3个月(P=0.011,OR=0.02)、术后9个月(P=0.014,OR=0.039)、术后12个月(P=0.014,OR=0.039)尿控是否恢复存在相关性。对于术后12个月仍存在尿失禁的患者,尿道横纹括约肌小于或等于1.6 mm,尿失禁较为严重[P=0.010,OR(95%置信区间)=(0.858,6.240)]。MUL与患者术后9个月(P=0.024,OR=0.508)及12个月(P=0.024,OR=0.508)尿控是否恢复呈正相关。前列腺体积、前列腺各径线、以及研究过程中纳入的可能与术后尿控情况存在相关性的因素在分析过程中显示无明显统计学意义。结论:尿道横纹肌厚度与患者早期尿控是否恢复呈正相关,且尿道横纹括约肌越薄,患者尿失禁程度越严重。MUL与早期尿控是否恢复呈正相关。年龄是LRP术后1个月尿控是否恢复的独立危险因素。需要进行长期随访的前瞻性研究进一步证实上述初步结果。