Laparoscopic radical prostatectomy: a European virus.

The evolution of prostate cancer treatment has now incorporated the principles of minimally invasive surgery. Laparoscopic radical prostatectomy, just like a virus, infected first Europe and three years ago the United States. This European virus has nowadays a potentially widespread application. Oncological efficacy and ability to preserve and improve continence and potency are the factors that will ultimately determine the role of laparoscopic radical prostatectomy and thus the future of this virus infection. This article reviews the current published experience with minimally invasive prostatectomy and provides comparisons to published data on radical retropubic prostatectomy to increase awareness about viability. Some prospective and retrospective non-randomized comparative studies of the two approaches are also included in the present review. The current practice patterns regarding urological laparoscopic surgery and the tendency of the urologic community in Europe and in the United States to establish minimally invasive radical prostatectomy in more urological departments are described.     

Minimally invasive radical prostatectomy

The development of advanced laparoscopic techniques and robot-assisted technology has resulted in several new surgical approaches for treating organ-confined prostate cancer. Outcomes with these new or minimally Invasive techniques should be assessed carefully to ensure that they are similar to or surpass patients' oncologic and functional outcomes after open radical prostatectomy. This article reviews the current published experience with minimally Invasive approaches to increase awareness about viability. Several of the larger series of patients who have undergone laparoscopic (transperitoneal and extraperitoneal) or robot-assisted laparoscopic radical prostatectomies are discussed and evaluated critically. Comparisons to published data on open radical prostatectomy are included for completeness. The different minimally invasive techniques are described and contrasted in regard to prostate-specific antigen progression-free survival, surgical margin status, blood loss, transfusion rates, postoperative pain, length of hospitalization, duration of urinary catheterization, potency, continence, and complications. The relative costs of each method are provided. The coexistence of multiple surgical approaches should and can challenge surgeons who perform open and minimally invasive procedures to strive for a new standard of care above and beyond what is accepted today to minimize patient morbidity while maximizing functional and oncologic outcomes.     

Laparoscopic radical robotic prostatectomy: a case study

The management of prostate cancer includes observation, hormonal therapy, radical prostate surgery (open, laparoscopic, or laparoscopic robotic), external beam radiation, brachytherapy, or cryotherapy. Laparoscopic radical robotic prostatectomy is the newest technology in minimally invasive surgery. This is a case study of a patient who chose to undergo laparoscopic robotic prostatectomy for his prostate cancer.     

A critical systematic review of recent clinical trials comparing open retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy

The surgical treatment of prostate cancer has evolved rapidly, driven by technological advances that have made minimally-invasive prostatectomy feasible. The contemporary surgical approaches are laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). These are now considered standard modalities of treatment in urology departments across North America, Europe and centres of excellence world-wide. However, despite the widespread adoption of minimally-invasive approaches there are only a handful of robust studies directly comparing the results of these techniques with the gold standard approach of open radical prostatectomy (ORP). Of note, uncertainty remains over exactly which men with localised prostate cancer will benefit from radical treatment and the reduction of surgical side-effects is paramount in optimising outcomes. This systematic review examines the current status of minimally- invasive prostatectomy focussing on peri-operative, oncological and urogenital functional outcomes.     

Minimally invasive surgery

Minimally invasive surgery is replacing the traditional open surgical approach for many abdominal procedures. The benefits of reduced pain, quicker return of oral intake, shorter hospitalizations, and improved cosmetic results all support the increasing use of the laparoscopic approach. This review identifies important articles published in the literature on minimally invasive surgery from June 2002 to August 2003, with the objective of identifying future trends and directions in laparoscopic surgery. The topics of articles reviewed in detail include minimally invasive techniques applied to esophageal tumors, morbid obesity, malignant liver tumors, gallbladder disease, pancreatic pathology, colon cancer, and robotic prostatectomy.     

Robotics in laparoscopic urology.

Following the successful application of the da Vinci robot in minimally invasive radical prostatectomy, several surgeries are now being performed with the assistance of the robot. These include both upper tract and lower tract surgeries such as nephrectomy, pyeloplasty and sacrocolpopexy and both ablative and reconstructive procedures. This article attempts to put into perspective the current role of the da Vinci Surgical system in urologic surgery and discusses in brief new developments in robotic technology that are on the horizon. A MEDLINE search was performed and published data on robot-assisted urologic procedures were reviewed. Abstracts presented at major international conferences in the last two years were also reviewed. Studies presenting operative and functional data for more than five patients were used in the review. There has been an explosive increase in the number of urologic procedures being attempted using Da Vinci assistance. Many, such as partial nephrectomy, donor nephrectomy, cystoprostatectomy, ureteral reimplantation and vasovasostomy are in the phase of feasibility studies, however others such as radical prostatectomy and pyeloplasty have one year functional results available which are comparable to those of other minimally invasive approaches. We believe that robotic technology represents the future of minimally invasive surgery and applications for the robot will expand as more centers report their results.     

Robotics in laparoscopic urology

Following the successful application of the da Vinci robot in minimally invasive radical prostatectomy, several surgeries are now being performed with the assistance of the robot. These include both upper tract and lower tract surgeries such as nephrectomy, pyeloplasty and sacrocolpopexy and both ablative and reconstructive procedures. This article attempts to put into perspective the current role of the da Vinci Surgical system in urologic surgery and discusses in brief new developments in robotic technology that are on the horizon. A MEDLINE search was performed and published data on robot‐assisted urologic procedures were reviewed. Abstracts presented at major international conferences in the last two years were also reviewed. Studies presenting operative and functional data for more than five patients were used in the review. There has been an explosive increase in the number of urologic procedures being attempted using Da Vinci assistance. Many, such as partial nephrectomy, donor nephrectomy, cystoprostatectomy, ureteral reimplantation and vasovasostomy are in the phase of feasibility studies, however others such as radical prostatectomy and pyeloplasty have one year functional results available which are comparable to those of other minimally invasive approaches.

We believe that robotic technology represents the future of minimally invasive surgery and applications for the robot will expand as more centers report their results.     

Endoscopic treatment for gastroesophageal reflux disease

The endoscopic treatment as a minimally invasive method to gastroesophageal reflux disease (GERD) came to be tried in addition to medication and laparoscopic antireflux surgery. Clinical trials, such as the Endoluminal Gastroplication method, the Full Thickness Plicator method, the Stretta method, the Enteryx method, and the Gatekeeper method, are advancing in the United States and Europe. It is necessary to consider the efficacy, safety, durability, cost effectiveness, an indication, etc. using data from a randomized controlled trial with sufficient observation period. If the usefulness of endoscopic treatment is confirmed in the future, the new minimally invasive strategy over GERD will be established.     

Laparoscopic radical prostatectomy

Prostate cancer is the second leading cause of cancer deaths among men, after lung cancer. Traditionally, the traumatic open radical prostatectomy procedure was the only treatment option available. Although nerve-sparing techniques have evolved, the development of laparoscopic radical prostatectomy (LRP) has been one of the most significant changes in surgical treatment of the disease. Like many minimally invasive abdominal procedures, LRP reduces trauma, resulting in less postoperative pain, reduced length of hospital stay, and more rapid return to normal activity when compared to open radical prostatectomy. This article describes the preoperative, Intraoperative, and postoperative care of a patient undergoing LRP. It is anticipated that LRP will be the future standard for treatment of prostate cancer that requires radical surgery. AORN J75 (April 2002) 762-782.     

Treatment options for localized prostate cancer

In the United States, more than 90 percent of prostate cancers are detected by serum prostate-specific antigen testing. Most patients are found to have localized prostate cancer, and most of these patients undergo surgery or radiotherapy. However, many patients have low-risk cancer and can follow an active surveillance protocol instead of undergoing invasive treatments. Active surveillance is a new concept in which low-risk patients are closely followed and proceed to intervention only if their cancer progresses. Clinical guidelines can help in selecting between treatment or active surveillance based on the cancer's stage and grade, the patient's prostate-specific antigen level, and the comorbidity-adjusted life expectancy. Radical prostatectomy or external beam radiation therapy is recommended for higher-risk patients. These treatments are almost equivalent in effectiveness, but have different adverse effect profiles. Brachytherapy is an option for low- and moderate-risk patients. Evidence is insufficient to determine whether laparoscopic or robotic surgery or cryotherapy is superior to open radical prostatectomy.     

Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs

Open retropubic radical prostatectomy is the gold standard treatment for localised prostate cancer. However, the procedure has inherent morbidity associated to it. Therefore, less invasive surgical techniques have been sought, one such alternative is robotic-assisted laparoscopic radical prostatectomy. The advantages provided by robotic technology have the potential to minimise patient morbidity while improving both functional and oncological outcomes. Although it is a recent technological advancement, robotic surgery has shown an increasing rate of adoption worldwide. Currently more than 30,000 patients have undergone this procedure worldwide. We present a review of the available literature on robotic-assisted laparoscopic radical prostatectomy.     

单孔腹腔镜手术器械研究的最新进展

背景：单孔腹腔镜外科手术因其创伤小、术后疼痛轻、住院时间短、美容效果好等特点,成为当今医学科技最前沿的发展方向。但是目前单孔腹腔镜手术器械较少且存在不足,不能满足微创外科的要求。目的：确认单孔腹腔镜手术的可行性,总结分析现存的几种单孔腹腔镜手术操作平台及多自由度器械,以期对单孔腹腔镜手术器械进行优化、改进,提高其应用能力。方法：利用计算机检索万方数据库、清华同方数据库、维普数据库、Springer Link全文电子期刊、IEEE数据库、Elsevier数据库、国家知识产权局专利、美国专利、欧洲专利,检索英文关键词为＂single-port access,laparoscopic surgery,minimally invasive surgery,ports,multi-degree-of-freedom instruments＂,中文关键词为＂单孔入路,腹腔镜外科,微创外科,平台,多自由度器械＂,主要筛选出近10年内最具代表性的文献资料。经查阅、整理出35篇可支持本综述的文献。结果与结论：单孔腹腔镜技术已成为现在微创外科的主流;现存的平台都已将多孔集中为单孔,达到对患者创伤更小的目的,但仍需在放置稳定性、经济性、功能整合等方面改进;现存的多自由度器械已通过增加关节的方式实现了多自由度运动,但过于复杂的传动机构、不甚便捷的控制系统以及过高的经济成本仍阻碍微创外科技术进一步的发展。     

Single port surgery: Review of the literature and our initial experience

This review summarizes the published data regarding single port surgery (SPS) in order to evaluate the current status of SPS. SPS is a rapidly evolving technique in minimally invasive surgery. A wide variety of SPS have been performed since 1992, including appendectomy, cholecystectomy, colectomy, inguinal hernia repair, liver cyst fenestration, and bariatric surgery, and the technical feasibility has been demonstrated. Further advancements in technology and technique may allow the broad acceptance of this new method. Prospective randomized trials comparing SPS to laparoscopic surgery are essential to further determine the advantages and disadvantages of SPS.     

后腹腔镜治疗上尿路疾病351例疗效观察

[目的]探讨后腹腔镜手术治疗上尿路疾病的方法和可行性.[方法]对本院2006年9月至2011年9月收治的351例上尿路疾病患者采用后腹腔镜下输尿管切开取石187例、肾囊肿去顶减压76例,单纯肾切除35例,肾肿瘤根治21例、肾盂输尿管成形术12例、肾蒂淋巴管结扎5例,肾上腺肿瘤切除11例、腔静脉后输尿管离断吻合术2例、肾盂癌根治术2例.[结果]351例中348例均获得成功,3例中转开放手术成功,无输血,无重大并发症,所有患者症状消失或好转,术后随访1～12个月未见原发病复发.[结论]后腹腔镜手术治疗泌尿外科疾病安全、有效、创伤小、出血少,患者术后恢复快.     

HIFU and cryoablation--non or minimal touch techniques for the treatment of prostate cancer. Is there a role for contrast enhanced ultrasound?

The incidence of prostate cancer is increasing, and therefore also the need for optimal treatment. Because of the appearance of many different disease stages different treatment modalities are desirable for the treatment of localized prostate cancer. The established therapies, radical prostatectomy and radiation therapy, are associated with a lot of risks, complications and co-morbidity, and not all patients are eligible for these treatments. That is why the need for reliable minimally invasive alternatives has developed. For this paper a literature search was conducted on published studies and review articles to determine the role of HIFU (high intensity focused ultrasound) and cryoablation as minimally invasive treatment modalities for localized prostate cancer. Both therapies are being used as a primary or secondary (salvage) treatment, but can they replace surgery or radiation? And is there a role for contrast enhanced ultrasound (CEUS) of the prostate to improve diagnostics, treatment outcomes and follow-up? To date the outcomes of both therapies are promising but no prospective and comparative randomized studies with a long term follow-up were available for analysis. From this review we can conclude that until those studies are available, HIFU and cryoablation are good alternatives for patients not eligible for prostatectomy or radiation. They should not be used as a first treatment option as long as diagnostics and follow-up have not improved.     

腹腔镜在泌尿外科重建手术中的应用

目的 为了提高腹腔镜在泌尿外科重建手术中的应用。方法 复习近年来有关文献，阐述了腹腔镜在泌尿外科重建手术中的适应证、临床操作要点和并发症等。结果 临床上已确立的腹腔镜重建手术如肾孟成形、根治性前列腺切除术和睾丸固定术；其他操作如肾部分切除术、肾动脉瘤修补术、输尿管输尿管吻合术、回肠输尿管成形术和膀胱扩大术等是新进展性手术。结论 期望未来的腹腔镜手术将会增加，并发展成为先进和复杂的泌尿外科重建手术的选择方法。     

Telepresence surgery: first experiences with laparoscopic radical prostatectomy

The concept of an intelligent steerable surgical instrument system has been described by various authors. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system, mainly for cardiac bypass surgery. We present our initial experience using the device for robot-assisted laparoscopic radical prostatectomy. The intuitive surgical system consists of two main components: the surgeon‘s viewing and control console with 3D-imaging, and the surgical arm unit that positions and manoeuvres detachable surgical instruments. These instruments are introduced via two 8 mm trocars and allow movements in all six degrees of freedom (DoF). The surgeon performs the procedure while seated at the console holding specially designed instruments. Highly specialised computer software and mechanics transmit the surgeon‘s hand movements exactly to the microsurgical movements of the manipulators at the operative site. The system used is a W-shaped five trocar arrangement, with the robot‘s arms at the lateral trocars (8 mm) and two assistant trocars medially (10 mm). A sixth trocar was used in the right suprapubic area for retraction of the gland (Foley catheter). The left assistant used different instruments, such as bipolar forceps, Ultracision, and Endoclip, wheras the right assistant mainly used the suction–irrigation device. The Intuitive System was attached after trocar placement and exposure of Retzius‘ space. We treated six patients (two pT2, four pT3, median Gleason score 6). The operating room time averaged 315 (range 242–480) min, including pelvic lymph-node dissection. No intra-operative complications occured, one patient required transfusions. There were no positive margins, median catheter time was 5 days. Three patients were completely continent after 1 month. Telerobotic laparoscopic radical prostatectomy is feasible. There is a learning curve with the device, mainly due to the magnification, 3D image and lack of tactile feedback. However, the experienced surgeon can become familiar with the device after a short time. There is still a need for further development of instruments for urological procedures.