单孔腹腔镜下经膀胱根治性切除猪前列腺的初步尝试

目的尝试单孔腹腔镜下经膀胱根治性切除猪前列腺,探讨其可行性,总结操作难点,为后续临床应用奠定基础。方法采用雄性未阉割香猪,全麻下进行膀胱外翻皮肤造口;将TriPort单孔多通道系统经造口处置入膀胱并固定;建立气膀胱后,用传统腹腔镜器械模拟人经膀胱前列腺根治性切除术;经膀胱完成膀胱内口与尿道吻合,经皮肤造口取出前列腺标本后关闭膀胱和腹腔。结果共完成了6例动物实验,前3例失败,原因为膀胱操作空间无法保证、吻合操作失败等;后3例均顺利完成,手术时间分别是190、160、110min,前列腺完整切除,间断吻合6针恢复尿道连续性。结论单孔腹腔镜下经膀胱猪前列腺根治性切除技术可行,但操作难度较大,鉴于猪解剖结构与人存在较大差异,需进一步在尸体模型上进行类似尝试,目前尚不适合向临床阶段过渡。

Single-port laparoscopic transvesical prostatectomy in pigs

Introduction: To study the feasibility of the single port transvesical radical prostatectomy in porcine model. Materials and methods: From June to July 2009, we performed the single port transvesical radical prostatectomy in six pigs. The instruments, details of the procedure and the results were summarized. Results: The first three procedures failed and the causes of failure were the inappropriate position of Triport system, the limited space of bladder and the tension of vesico-urethral anastomosis. After improving some techniques, the following three experiments were successful. The procedure time were 190,160 and 110 minutes, respectively. Conclusions: The single-port transvesical radical prostatectomy may be a kind of surgery, which has a future. However, limited by the instruments, now it is a unwise choice to apply this surgery in the clinic research.