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 an...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.展开更多
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 ...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.展开更多
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 fu...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.展开更多
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 sign...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.展开更多
Objective:Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement,open simple prostatectomy(OSP)remains the standard for large prostates(typically greater than 100 g).OSP,...Objective:Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement,open simple prostatectomy(OSP)remains the standard for large prostates(typically greater than 100 g).OSP,however,is associated with significant morbidity.Recently,a few reports touting robotic application to simple prostatectomy have been published.Herein,we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy(RALSSP)and detailed modifications in our technique as our experience increased.Methods:All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics,pre-operative features,and perioperative outcomes.All parameters were tabulated and mean values were calculated.Student’s t-test was utilized with p<0.05 deemed significant.Details regarding surgical technique were reviewed and highlighted.Results:Fifteen patients underwent RALSSP during this period.Mean age of these men was 68.7 years.Mean body mass index(BMI)was 28.5 kg/m^2.American Society of Anesthesiologists(ASA)score was on average 2.6.Average International Prostate Symptom Score(IPSS)was 16.2 with the majority of men experiencing some adverse clinical sequela of such benign prostatic hyperplasia(BPH).For those patients not in retention,preoperative post-void residual(PVR)was 428 mL.All patients underwent successful RALSSP without need for conversion or need for blood transfusion.Mean estimated blood loss(EBL)was 290 mL.Five patients underwent other concurrent procedures(e.g.,cystolithotomy).Mean length of hospital stay(LOS)was 2.4 days and only five patients required continuous bladder irrigation(CBI)postoperatively.Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5(p<0.001).No major complications were identified.Adaptation of low transverse cystotomy,utilization of a robotic tenaculum in the#3 arm with its control by a surgeon on a second console,and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative outcomes.Conclusion:RALSSP allows for feasible performance of prostate adenoma enucleation with low risk of blood transfusion,short LOS,and significant improvement in IPSS and PVR;all while maintaining a minimally invasive approach.The use of a robotic tenaculum controlled by the secondary console and the mucosal advancement facilitate excellent outcomes and may play a role in minimizing hematuria and need for CBI.展开更多
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 patie...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.展开更多
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 statu...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.展开更多
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 prost...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.展开更多
Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple prostatectomy.Since the first report,RASP underwent several technical modificati...Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple prostatectomy.Since the first report,RASP underwent several technical modifications.The study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia(BPH).Methods:The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020,assessing robot-assisted surgical techniques for BPH treatment using the terms“robot-assisted simple prostatectomy”OR“robotic simple prostatectomy”OR“RASP”AND“surgical technique”.Results:After careful review of 180 studies in PubMed and 198 in Embase,16 papers reporting different RASP techniques.After the first procedure described by Sotelo et al.[9],several authors contributed to the development of the RASP technique.John et al.[24]proposed the extraperitoneal access,and Yuh et al.[23]first reported the adenoma transcapsular dissection.Some modifications were proposed by Coelho et al.[31]on trigonization,posterior reconstruction,and urethro-vesical anastomosis.Other groups focused on urethral-preserving procedures.Moschovas et al.[28]and Clavijo et al.[32]recently described an intrafascial RASP with the removal of the entire prostatic tissue.Finally,Kaouk et al.[29]reported the feasibility and safety of the da Vinci Single Port approach.Conclusion:In the last eighteen years,the robotic-assisted approach to BPH disease has been evolved,and different techniques have been described.This review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.展开更多
To examine the outcomes of patients with high-risk prostate cancer （PCa） treated by robot-assisted radical prostatectomy （RARP） and evaluate the value of multi-parametric magnetic resonance imaging （MRI） in esti...To examine the outcomes of patients with high-risk prostate cancer （PCa） treated by robot-assisted radical prostatectomy （RARP） and evaluate the value of multi-parametric magnetic resonance imaging （MRI） in estimating tumor stage, extracapsular extension, and grade, and the application of nerve sparing （NS） techniques. Patient demographics, preoperative imaging, surgical parameters, pathological features, functional and recurrence outcomes were collected retrospectively in patients with high-risk PCa who underwent RARP between December 2009 and October 2013. Pathological whole mount slides to assess NS were compared with potency, recovery of continence, and surgical margins （SM）. Forty-four cases of high-risk PCa were identified with a median followup of 24 months and positive surgical margins （PSM） rate of 14%. Continence returned in 86%, with potency rate of 58%. Of the 25 cases with a preoperative multi-parametric MRI, MRI improved clinical staging from 28% to 88%, respectively. Following risk stratification of NS by microscopic analysis of whole mount pathology, patients with Group A （bilateral NS）, Group B （unilateral NS）, Group C （partial NS）, and Group D （non-NS） had 100%, 92%, 91%, and 50% continence rates, and 100%, 80%, 45%, and 0% potency rates, respectively, with an inverse correlation to PSM. RARP in men with high-risk PCa can achieve favorable oncologic and functional outcomes. Preoperative MRI may localize high-grade tumors and improve clinical staging. Extent of NS is influenced by clinical staging and may balance potency and continence with PSMs.展开更多
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,thi...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.展开更多
Background:This study is aimed to analyze the effect of social distancing on functional outcomes(potency,continence recovery,and quality of life)on patients undergoing open radical prostatectomy(ORP)and robot-assisted...Background:This study is aimed to analyze the effect of social distancing on functional outcomes(potency,continence recovery,and quality of life)on patients undergoing open radical prostatectomy(ORP)and robot-assisted radical prostatectomy(RARP)during the coronavirus disease 2019(COVID-19)pandemic.Materials and methods:We retrospectively assessed functional outcomes of 55 consecutive patients who underwent radical prostatectomy during the COVID-19 pandemic(group A:12 ORP and 15 RARP)and compared these data with patients from the previous year(group B:13 ORP and 15 RARP).Propensity-score matching was performed to analyze variables associated with potency,continence recovery and compared between the groups at 1 and 3months.Results:Patients from group A were less interested in postsurgical rehabilitation compared to those from group B(95.7%vs.56.2%,p=0.042).Continence recovery among group B patients also tended to be higher for RARP(p=0.06)and ORP(p=0.08)at 1 month,although statistical significance was not reached.The cumulative continence recovery at 3months among group B patients was higher and statistically significantly advantageous for RARP(p=0.00)and ORP(p<0.01).Potency rates among younger group B patients following bilateral nerve-sparing procedures were statistically significantly advantageous for RARP(p=0.026)and ORP(p=0.011).Conclusions:Our results highlight the large impact of the COVID-19 pandemic on functional outcomes following radical prostatectomy.Future design and planning of home-based models for improved post-operative care should consider this evidence.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘Objective:Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement,open simple prostatectomy(OSP)remains the standard for large prostates(typically greater than 100 g).OSP,however,is associated with significant morbidity.Recently,a few reports touting robotic application to simple prostatectomy have been published.Herein,we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy(RALSSP)and detailed modifications in our technique as our experience increased.Methods:All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics,pre-operative features,and perioperative outcomes.All parameters were tabulated and mean values were calculated.Student’s t-test was utilized with p<0.05 deemed significant.Details regarding surgical technique were reviewed and highlighted.Results:Fifteen patients underwent RALSSP during this period.Mean age of these men was 68.7 years.Mean body mass index(BMI)was 28.5 kg/m^2.American Society of Anesthesiologists(ASA)score was on average 2.6.Average International Prostate Symptom Score(IPSS)was 16.2 with the majority of men experiencing some adverse clinical sequela of such benign prostatic hyperplasia(BPH).For those patients not in retention,preoperative post-void residual(PVR)was 428 mL.All patients underwent successful RALSSP without need for conversion or need for blood transfusion.Mean estimated blood loss(EBL)was 290 mL.Five patients underwent other concurrent procedures(e.g.,cystolithotomy).Mean length of hospital stay(LOS)was 2.4 days and only five patients required continuous bladder irrigation(CBI)postoperatively.Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5(p<0.001).No major complications were identified.Adaptation of low transverse cystotomy,utilization of a robotic tenaculum in the#3 arm with its control by a surgeon on a second console,and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative outcomes.Conclusion:RALSSP allows for feasible performance of prostate adenoma enucleation with low risk of blood transfusion,short LOS,and significant improvement in IPSS and PVR;all while maintaining a minimally invasive approach.The use of a robotic tenaculum controlled by the secondary console and the mucosal advancement facilitate excellent outcomes and may play a role in minimizing hematuria and need for CBI.
文摘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.
文摘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.
基金supported by the National Natural Science Foundation of China(No.91959114 and 81872106)the Second Hospital of Tianjin Medical University Clinical Medicine Research Project(No.2018KYLC007 and 2019LC02).
文摘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.
文摘Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple prostatectomy.Since the first report,RASP underwent several technical modifications.The study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia(BPH).Methods:The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020,assessing robot-assisted surgical techniques for BPH treatment using the terms“robot-assisted simple prostatectomy”OR“robotic simple prostatectomy”OR“RASP”AND“surgical technique”.Results:After careful review of 180 studies in PubMed and 198 in Embase,16 papers reporting different RASP techniques.After the first procedure described by Sotelo et al.[9],several authors contributed to the development of the RASP technique.John et al.[24]proposed the extraperitoneal access,and Yuh et al.[23]first reported the adenoma transcapsular dissection.Some modifications were proposed by Coelho et al.[31]on trigonization,posterior reconstruction,and urethro-vesical anastomosis.Other groups focused on urethral-preserving procedures.Moschovas et al.[28]and Clavijo et al.[32]recently described an intrafascial RASP with the removal of the entire prostatic tissue.Finally,Kaouk et al.[29]reported the feasibility and safety of the da Vinci Single Port approach.Conclusion:In the last eighteen years,the robotic-assisted approach to BPH disease has been evolved,and different techniques have been described.This review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.
文摘To examine the outcomes of patients with high-risk prostate cancer （PCa） treated by robot-assisted radical prostatectomy （RARP） and evaluate the value of multi-parametric magnetic resonance imaging （MRI） in estimating tumor stage, extracapsular extension, and grade, and the application of nerve sparing （NS） techniques. Patient demographics, preoperative imaging, surgical parameters, pathological features, functional and recurrence outcomes were collected retrospectively in patients with high-risk PCa who underwent RARP between December 2009 and October 2013. Pathological whole mount slides to assess NS were compared with potency, recovery of continence, and surgical margins （SM）. Forty-four cases of high-risk PCa were identified with a median followup of 24 months and positive surgical margins （PSM） rate of 14%. Continence returned in 86%, with potency rate of 58%. Of the 25 cases with a preoperative multi-parametric MRI, MRI improved clinical staging from 28% to 88%, respectively. Following risk stratification of NS by microscopic analysis of whole mount pathology, patients with Group A （bilateral NS）, Group B （unilateral NS）, Group C （partial NS）, and Group D （non-NS） had 100%, 92%, 91%, and 50% continence rates, and 100%, 80%, 45%, and 0% potency rates, respectively, with an inverse correlation to PSM. RARP in men with high-risk PCa can achieve favorable oncologic and functional outcomes. Preoperative MRI may localize high-grade tumors and improve clinical staging. Extent of NS is influenced by clinical staging and may balance potency and continence with PSMs.
文摘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.
文摘Background:This study is aimed to analyze the effect of social distancing on functional outcomes(potency,continence recovery,and quality of life)on patients undergoing open radical prostatectomy(ORP)and robot-assisted radical prostatectomy(RARP)during the coronavirus disease 2019(COVID-19)pandemic.Materials and methods:We retrospectively assessed functional outcomes of 55 consecutive patients who underwent radical prostatectomy during the COVID-19 pandemic(group A:12 ORP and 15 RARP)and compared these data with patients from the previous year(group B:13 ORP and 15 RARP).Propensity-score matching was performed to analyze variables associated with potency,continence recovery and compared between the groups at 1 and 3months.Results:Patients from group A were less interested in postsurgical rehabilitation compared to those from group B(95.7%vs.56.2%,p=0.042).Continence recovery among group B patients also tended to be higher for RARP(p=0.06)and ORP(p=0.08)at 1 month,although statistical significance was not reached.The cumulative continence recovery at 3months among group B patients was higher and statistically significantly advantageous for RARP(p=0.00)and ORP(p<0.01).Potency rates among younger group B patients following bilateral nerve-sparing procedures were statistically significantly advantageous for RARP(p=0.026)and ORP(p=0.011).Conclusions:Our results highlight the large impact of the COVID-19 pandemic on functional outcomes following radical prostatectomy.Future design and planning of home-based models for improved post-operative care should consider this evidence.
