国产单孔蛇形臂机器人手术系统在零缺血肾部分切除术中的初步应用

目的:探讨术锐单孔蛇形臂机器人手术系统用于零缺血肾部分切除术的可行性和安全性。方法:2021年5—10月,前瞻性纳入因肾肿瘤拟行零缺血肾部分切除术的患者。纳入标准：年龄≥18岁;单发肾肿瘤,肿瘤最大径≤4 cm;体质指数(BMI)18.5~30.0 kg/m 2;美国麻醉医师协会评分1~3分;能配合完成方案...     

国产单孔蛇形臂机器人辅助腹腔镜行肾部分切除术初步经验

目的:探讨国产单孔蛇形臂机器人在治疗肾肿瘤患者中的安全性和有效性。方法:回顾性分析多中心2021年10月—2022年6月共22例接受国产单孔蛇形臂机器人行肾部分切除术患者的临床资料。结果:本研究22例患者中,男12例,女10例,平均年龄为51.6(27～72)岁。术后病理类型：血管平滑肌脂肪瘤8例,良性囊肿伴周围脂肪组织瘤样增生1例,嫌色细胞癌2例,透明细胞癌9例,嗜酸细胞型乳头状细胞癌1例,嗜酸细胞腺瘤1例。手术台操作时间平均为129.4(52～230) min,术中热缺血时间平均为26.9(14～38) min,预计出血量平均为36.9(2～200) mL。术后均无Clavien分级Ⅱ级及以上并发症发生。结论:国产单孔蛇形臂机器人行肾部分切除术是治疗肾癌患者安全有效的方法。     

单一术者机器人辅助单孔腹腔镜前列腺癌根治术学习曲线分析

目的 评估单一术者在不同时间段开展的机器人辅助单孔腹腔镜前列腺癌根治术（sp-RALP）之手术效果,探讨该手术方式的学习曲线。方法 回顾性分析南京中医药大学附属医院2020年1月至2020年12月由同一手术医师连续完成的100例sp-RALP的临床资料。按时间顺序将患者分为5组（A组即第一阶段组为第1～20例,B组即第二阶段组为第21～40例,C组即第三阶段组为第41～60例,D组即第四阶段组为第61～80例,E组即第五阶段组为第81～100例）,比较5组间的手术时间、术中出血、引流管留置时间、术后住院天数等方面的差异。结果 随术者经验例数的累积,手术时间、术中出血量均呈下降趋势,A、B两组与C、D、E三组间分别对比差异均有统计学意义（P均<0.05）,A组与B组间对比仅手术时间的差异存在统计学意义（P<0.05）,C、D、E三组间两两对比差异均无统计学意义（P均>0.05）;而引流管留置时间、术后住院天数各组间研究的差异均无统计学意义（P均>0.05）。结论 机器人辅助单孔腹腔镜前列腺癌根治术（sp-RALP）学习曲线相对陡峭,大约在40例手术经验积累之后基本...     

机器人辅助腹腔镜前列腺癌根治术

前列腺癌好发于中老年男性,是目前最常见的泌尿系统恶性肿瘤之一.在美国,前列腺癌是发病率仅次于皮肤癌的男性恶性肿瘤,在肿瘤相关死亡原因中排在第二位.随着社会的人口老龄化、生活习惯的改变、前列腺癌检出率的提高,我国前列腺癌的发病率正逐年上升.关于前列腺癌的手术治疗近年有较多进展,其中手术机器人的出现使前列腺癌的微创外科治疗进入了新的时代,现简单阐述如下.     

机器人前列腺癌根治术VIP手术技术

前列腺癌是男性生殖系统常见的恶性肿瘤.前列腺癌根治术是其治疗的重要手段之一.机器人前列腺癌根治术作为一种新兴的治疗手段已越来越多地被广大医患所接受.美国底特律Henry Ford医院的Vattikuti泌尿外科研究所的手术小组在Mani Menon教授领导下实施了近5000例机器人前列腺癌根治术,提出了VIP(Vattikuti Institute Prostatectomy)手术技术.该术式较好地保留了某些患者的性功能,术后尿控效果良好.本文简要介绍VIP技术.     

单孔腹腔镜前列腺癌根治术：附5例报告

目的报道经脐部单孔多通道腹腔镜前列腺癌根治术手术的初步经验。方法 2010年6月至2010年11月,对5例TNM分期为T1b～T2的前列腺癌患者行经腹途径单孔腹腔镜前列腺癌根治术,所有患者既往无盆腔手术史。经脐部切口,长约4cm,置入单孔多通道设备（Quadport）,在此切口之外无附加任何其他操作通道。结果 5例手术均获得成功,无一例中转开放或传统腹腔镜手术。手术时间185～370min,平均303min。术中出血量220～650ml,平均431ml,无一例患者需输血。术后留置尿管时间12～21d,平均17d。无直肠损伤等并发症。术后住院时间12～25d,平均19d。所有病例术后病理均报告前列腺包膜完整,肿瘤切缘均为阴性。所有5例患者术后随访2～15周,控尿恢复良好,每天使用尿片约0～2片。结论单孔腹腔镜前列腺癌根治术是安全有效的治疗方法。     

机器人单孔经膀胱入路前列腺癌根治术的护理配合

目的:总结机器人辅助单孔经膀胱入路前列腺癌根治术的手术护理配合经验。方法:选择7例行机器人辅助单孔经膀胱前列腺癌根治术的患者,对术前准备、术中配合和术后整理经验进行总结。结果:7例患者的手术均在全机器人辅助腹腔镜下完成,无中转开放,平均手术时间为2.5h,术中平均出血量为50ml,平均住院天数为5d。术后未放置腹腔引流管,无护理相关并发症,所有患者拔管后尿控良好。医护人员做到有效沟通、团队协作,将优质护理贯穿于整个围术期;洗手护士、巡回护士分工合作,保障了手术患者的安全。结论:对行机器人辅助单孔经膀胱入路前列腺癌根治术的患者进行的手术期护理可以提高手术效率,降低手术风险,缩短患者住院时间,值得进一步推广。     

国产手术机器人辅助单孔腹腔镜技术在泌尿外科的初步应用

目的：探讨国产“图迈”手术机器人辅助单孔腹腔镜技术在泌尿外科手术中的安全性及可行性。方法：回顾性分析2022年2月—2022年5月在南京医科大学附属克州人民医院泌尿外科行机器人辅助单孔腹腔镜手术的6例患者的临床资料,观察患者的性别、年龄、既往手术史、术前诊断、手术方式、合并症、手术时间、术中出血量以及术后住院时间等指标。结果：所有手术均顺利完成,其中2例精索静脉曲张高位结扎术,1例肾盂输尿管切开取石术,1例肾囊肿去顶减压术,1例膀胱切开取石术,1例肾部分切除术。所有患者平均手术时间为（93.33±33.12）min,术中出血量为（42.50±30.65）ml,术后住院时间为（3.33±1.49）d。术后1个月随访,所有患者伤口愈合良好。结论：“图迈”手术机器人辅助单孔腹腔镜技术在泌尿外科的应用是安全、有效的,但仍需更大样本量的临床研究加以验证。     

国产手术机器人辅助单孔腹腔镜技术在泌尿外科的初步应用

目的:探讨国产“图迈”手术机器人辅助单孔腹腔镜技术在泌尿外科手术中的安全性及可行性。方法:回顾性分析2022年2月—2022年5月在南京医科大学附属克州人民医院泌尿外科行机器人辅助单孔腹腔镜手术的6例患者的临床资料,观察患者的性别、年龄、既往手术史、术前诊断、手术方式、合并症、手术时间、术中出血量以及术后住院时间等指标。结果:所有手术均顺利完成,其中2例精索静脉曲张高位结扎术,1例肾盂输尿管切开取石术,1例肾囊肿去顶减压术,1例膀胱切开取石术,1例肾部分切除术。所有患者平均手术时间为(93.33±33.12)min,术中出血量为(42.50±30.65)ml,术后住院时间为(3.33±1.49)d。术后1个月随访,所有患者伤口愈合良好。结论:“图迈”手术机器人辅助单孔腹腔镜技术在泌尿外科的应用是安全、有效的,但仍需更大样本量的临床研究加以验证。     

腹膜外入路经脐单孔腹腔镜前列腺癌根治术围手术期护理：附11例报告

目的报道使用自制多通道套管经脐切口行单孔腹腔镜前列腺根治性切除术护理体会。方法2009年8月至2010年3月,对11例局限性前列腺癌患者行单孔腹腔镜下前列腺根治性切除术,配合围手术期的各项处理。观察术后手术切口护理、管道护理、疼痛评估、控尿训练的效果。结果11例手术均顺利完成,1例术后膀胱尿道吻合口漏,2例淋巴漏,1例泌尿系感染,经保守治疗治愈。患者术后第3天平均疼痛评分为1．5／10（0．5）。5例尿失禁观察6个月恢复完全控尿。结论做好围术期护理,特别是术前心理护理、肠道准备和术后管道护理,控尿训练对确保手术的成功,提高患者的自理能力和生存质量起着重要的作用。     

经腹膜外机器人单孔腹腔镜根治性前列腺切除术的初步应用

经腹膜外机器人单孔腹腔镜根治性前列腺切除术的研究国内鲜有报道。本研究对9例局限性前列腺癌患者采用经腹膜外机器人单孔腹腔镜根治性前列腺切除术,手术均顺利完成,无额外增加辅助孔。手术时间及出血量可控,住院时间短。术后短期随访肿瘤控制及功能恢复效果满意,该术式安全可行,但远期疗效需进一步观察。     

“超级面纱法”腹膜外单孔机器人前列腺癌根治术的手术技巧体会与临床应用分析

目的:描述"超级面纱法"腹膜外单孔机器人前列腺癌根治术(super-veil extraperitoneal single-port robotic assisted radical prostatectomy, sesRARP)的手术步骤,总结短期随访结果,探讨其最佳应用场景。方法:回顾性分析2018年12月—2021年6月行sesRARP的41例器官局限性前列腺癌患者的临床资料。年龄52～79岁,平均(63.9±4.3)岁;前列腺特异性抗原(PSA)中位数8.70(6.35,11.84) ng/mL,中位前列腺体积32.90(28.98,33.85) mL,术前排尿功能正常,规律行性生活。术中取耻骨上5 cm横切口。性神经保留采用"超级面纱法",将双侧血管神经束及腹侧的背深静脉丛、逼尿肌裙与耻骨膀胱韧带紧贴前列腺包膜完整分离。记录围术期并发症、出院前疼痛评分、住院天数、PSA随访指标、尿控恢复时间、性功能恢复时间等。结果:平均手术时间(93.3±28.29) min。术中出血量72.7(50～150) mL,未输血。切缘阳性率为14.6%(6/41)。术后住院天数为3(1.0,3....     

Robotic radical prostatectomy: advantages of an initial posterior dissection

During robotic radical prostatectomy (RRP), many surgeons currently employ the modified-Montsouris technique as initially described by Menon in 2002 with initial anterior prostate dissection. The anterior approach simulates the routine retropubic technique which open surgeons feel most comfortable with. Unfortunately, we observed early on in our experience that dissection of the seminal vesicles (SV) and vas deferens (VD) through a limited sized bladder neck posed limitations on working space and anatomic differentiation. As such, we have continued using a posterior-first dissection for several specific advantages. Herein, we describe our initial posterior dissection during RRP and discuss potential advantages of this approach, particularly for novice robotic surgeons. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Robotic-assisted radical prostatectomy by a single surgeon in Taiwan: experience with the initial 30 cases

Robotic-assisted laparoscopic radical prostatectomy (RALP) is an established trend in surgical treatment for localized prostate cancer in the USA; however, RALP is still in its infancy in Taiwan. We have tracked various indicators of proficiency as a single Taiwanese surgeon became familiar with the procedure through experience with 30 initial RALP surgeries using the da Vinci system between December 2005 and April 2007. Here, we report the changes in these proficiency indicators, and the short-term outcomes for the patients. Thirty consecutive patients were classified into group 1 (cases 1–15) and group 2 (cases 16–30). Preoperative clinical characteristics, including age, body mass index (BMI), American Society of Anesthesiologists anesthetic surgical risks class (ASA), prostate-specific antigen levels (PSA), and Gleason scores were similar between the groups. The clinical stage (T1/T2) was significantly higher in group 2 than in group 1 (p = 0.028). Group 1 needed more frequent insertion of a double-J stent (60% versus 0%) before surgery and evaluation by cystogram before removal of urethral catheter (80% versus 6.7%) than group 2; these differences were statistically significant. Blood loss and transfusion rates were lower in group 2, but complication and conversion rates were higher in group 1. These differences were not statistically significant. Positive surgical margins, continence rates, potency, and intercourse rates at 12 months were similar between the groups. Console time was 262 min in group 1 and 190 min in group 2 (p = 0.033); this appeared to be the best indicator of proficiency. Establishing proficiency as determined by functional outcomes required about 30 cases, but the positive surgical margin rates indicate that experience with more than 30 cases was needed to ascend the learning curve with respect to oncological outcomes.     

Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis

BackgroundThe purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy.MethodsUsing the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data.ResultsA total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I²=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I²=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I²=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I²=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited.DiscussionOur results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.     

经腹膜外腹腔镜前列腺癌根治术（附9例报告）

目的探讨经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法我科自2006年1月至2008年10月对9例前列腺癌患者行经腹膜外途径腹腔镜前列腺癌根治术,手术经腹膜外路径顺行切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体。结果9例手术均获得成功,无中转开放手术。手术时间180-510min,平均322min,术中出血量200-1500ml,平均433ml,术后48h内胃肠功能恢复,术后2～3d下床活动,无直肠损伤和吻合口尿漏出现。标本切缘阳性1例。1例患者术后半年仍有轻度尿失禁。其中7例患者随访5～33个月,未发现肿瘤局部和生化复发和远处转移;术后3个月前列腺特异性抗原0～0．1ng／ml。结论经腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法,手术创伤小,患者恢复快,腹腔并发症少。但该手术难度较大,需要具有丰富腹腔镜操作经验的医生完成。     

腹腔镜前列腺癌根治术的初步体会

目的:总结腹腔镜前列腺癌根治术围手术期并发症发生情况,并分析原因,总结手术经验体会。方法:回顾分析2011年1月至2016年3月开展的55例腹腔镜前列腺癌根治术患者的临床资料及术后随访资料,评估围手术期并发症情况。结果:55例患者均成功完成腹腔镜手术,无一例中转开放手术。术后平均住院(16.69±2.92)d,术后留置尿管时间平均(14.73±1.41)d,未发生多器官功能衰竭或死亡病例,并发症严重程度评估依据Clavien系统分级,共发生2例轻微并发症,为吻合口瘘、尿失禁各1例,并发症发生率为3.6%,未发生其他严重并发症。结论:腹腔镜前列腺癌根治术在围手术期并发症控制方面具有一定优势,但腹腔镜前列腺癌根治术的学习曲线较长,需要一定的腹腔镜手术经验及手术技巧的积累。     

Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study

OBJECTIVES: To prospectively compare intra- and peri-operative outcomes of open radical retropubic prostatectomy (RRP) and laparoscopic prostatectomy (LRP) by a single surgeon. PATIENTS AND METHODS: One-hundred-twenty, consecutive, age-matched patients diagnosed with clinically localized prostate cancer were eligible for surgery. Sixty patients underwent RRP and 60, LRP. Intra- and peri-operative parameters, pathologic findings and early complications were recorded. A validated visual analogue scale was used to assess pain in the recovery room, 3 h after the operation and on post-operative days 1, 2 and 3. A cystogram was performed on post-operative day 5. RESULTS: Operating time was significantly shorter in the RRP group versus the LRP group (mean+/-SD, 170+/-34. 2 vs 235+/-49.9 min, p<0.001). Blood loss was significantly less in the LRP group versus the RRP group (mean+/-SD, 853.3+/-485 vs 257.3+/-177 ml, p<0.001), but no patient in either group underwent early re-intervention for bleeding. The RRP group showed a trend for higher use of analgesia. A watertight anastomosis was shown at cystourethrography and the catheter removed in 86% and 66% of LRP and RRP patients, respectively. The overall percentage of post-operative complications and positive margins were comparable. CONCLUSION: Laparoscopic prostatectomy is an attractive alternative to open prostatectomy, offering the advantages of reduced blood loss and safe early catheter removal. Furthermore, the laparoscopic procedure proved to be safe oncologically. Long-term follow-up is required to compare functional results in terms of continence and potency.     

Port site and peritoneal metastases after robot-assisted radical prostatectomy

INTRODUCTION

Port site metastasis after minimally invasive urologic surgery is a rare event despite the widespread utility of laparoscopic techniques in the management of urologic malignancies. Herein, we report a case of port site metastasis after robot-assisted radical prostatectomy.

PRESENTATION OF CASE

A currently 77-year-old male patient, who was diagnosed with cT2c, Gleason 7 (4 + 3) prostate adenocarcinoma in our clinic back in 2009, had undergone robot-assisted radical prostatectomy elsewhere. Histopathological examination revealed pT3a, Gleason 9 (4 + 5) disease. Lymph nodes were negative, however surgical margins were positive on the right side. PSA recurred after 9 months and maximal androgen blockade was initiated. Despite antiandrogenic manipulations, PSA reached 0.83 ng/ml, 33 months postoperatively. Concurrently, we noticed a palpable anterior abdominal mass which demonstrated metabolic hyperactivity on PET scanning. Percutaneous biopsy of the lesion confirmed the presence of metastatic adenocarcinoma. PSA did not normalize after the complete excision of the metastatic focus. Repeated PET scan revealed multiple implants on the peritoneal surfaces of various organs.

DISCUSSION

Port site and peritoneal metastasis of prostate cancer after robot-assisted radical prostatectomy has not been reported so far. This peculiar dissemination pattern is most probably the result of tumor biology and perioperative factors.

CONCLUSION

Although encountered extremely rarely, surgeons should be aware of the possibility of port site and/or peritoneal metastases after minimally invasive radical prostatectomy.