机器人辅助根治性膀胱前列腺切除术＋原位双U形回肠代膀胱术

目的探讨da-Vinci机器人辅助腹腔镜下行根治性膀胱前列腺切除术的可行性和疗效。方法患者男性,64岁,膀胱镜检膀胱内多发性占位,CT检查无远处转移。手术采用3臂2辅助孔,da-Vinci机器人辅助腹腔镜下全膀胱切除＋前列腺切除,盆腔淋巴结清扫,体外开放手术下取出切除的膀胱、前列腺,原位双U形回肠代膀胱术。观察手术时间、术中失血量、术后肠道功能恢复、术后并发症及手术效果。结果手术时间330min（包括体位摆放及da-Vinci机器人到位30min）,其中全膀胱切除180min,原位膀胱术120min。手术失血量800ml,输红细胞600ml,血浆300ml。术后病理：膀胱尿路上皮癌。术后第10天拔除双侧输尿导管,术后3周拔除导尿管,未发生手术并发症及术后并发症,尿控良好。结论 da-Vinci机器人辅助腹腔镜下根治性膀胱前列腺切除术可以明显减少术中出血,恢复快,缩短住院时间。机器人将复杂的盆腔腹腔镜手术变得简单易行,提高了手术的精细度和灵巧性。

Robot-assisted laparoscopic radical cystectomy with double U-shaped ileal neobladder

Objective To assess the feasibility and safety of robot-assisted laparoscopic radical cystectomy（rLRC） with double U-shaped ileal neobladder.Methods One case of bladder carcinoma underwent rLRC by a dedicated team using the da-Vinci robotic surgical system in April 2010.The man was 64 years old,and had histologically-confirmed bladder urothelial cancer diagnosed by cystoscopy and a negative bone scan.Bladder and prostate were removed by robot-assisted laparoscopic and followed by the reconstruction of bladder using double U-shape ileal neobladder.Peri-operative and early surgical outcome data were collected prospectively and functional recovery was assessed by an independent oncology nurse clinician.Results The operative time was 330 minutes,including 30 minutes of the preoperative set up time of the robot,and resection time was 300 minutes.The perioperative blood loss 800 ml,and transfusion 300 ml.Oral feeding was resumed on the 4th postoperative day.The ureteral catheters were removed on the 10th postoperative day,and the urethral catheter removed on the 21th postoperative day.Pathological assessment showed T3aN0M0.The postoperative process was uneventful and the automatic micturition was restored.Conclusions Robot-assisted rLRC showed significantly less peri-operative blood loss,shorter hospital stay and quicker diet resumption.With the help of da-Vinci robotic surgical system,the formerly complicated laparoscopic surgery in the pelvic cavity is being more straightforward more accurate and more dexterous.