Robotic-assisted laparoscopic radical prostatectomy

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ROBOTIC-ASSISTED radical prostatectomy uses the newest technology for surgical treatment of men with prostate cancer. Cancer of the prostate is the most common cancer in men and the second leading cause of death in American men.

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THE BENEFITS of robotic-assisted prostate surgery over open radical prostatectomy include small portal incisions, decreased blood loss, and shorter hospital stays.

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MAGNIFICATION of the surgeon's field of vision and jointed laparoscopic instruments that mimic the human wrist allow precision of movement and the ability to spare nerves, which result in improved postoperative urinary continence and sexual function. AORN J 84 (November 2006) 760-770. © AORN, Inc, 2006.

     

Transperitoneal laparoscopic radical prostatectomy

The diagnosis of prostate cancer for any male of any age can profoundly affect his life and that of his family. Improvements in laparoscopic devices, combined with associated surgical equipment and innovative urologic uses, have changed the treatment choices and outcomes for these types of patients. Transperitoneal laparoscopic radical prostatectomy (TLRP) offers improved postoperative outcomes for patients with localized prostatic cancer, decreasing the profound postoperative effects on functional return and potency. Quantitative advantages of TLRP include increased safety, lower hospital costs, and length of stay, while qualitative advantages include increased patient satisfaction, accelerated recovery, and qualitatively improved functional return.     

延续性护理在机器人辅助腹腔镜前列腺癌根治术后患者中的应用

目的：分析延续性护理在机器人辅助腹腔镜前列腺癌根治术后患者中的应用效果。方法：选取48例机器人辅助腹腔镜前列腺癌根治术的前列腺癌患者,随机分为观察组和对照组各24例,对照组实施常规护理,观察组实施电话、微信以及视频宣教、回馈教学等方法的延续性护理,共干预3个月。对两组患者应用生命质量测定量表、90项症状清单评分和尿失禁问卷简表进行效果对比。结果：观察组患者在疼痛、疲乏、便秘、失眠、总体健康状况方面均优于对照组;观察组患者在躯体化、人际关系、抑郁、焦虑、偏执、精神性方面均优于对照组;观察组患者尿失禁发生率低于对照组;差异均具有统计学意义 (P<0.05)。结论：对接受机器人辅助腹腔镜前列腺癌根治术的前列腺癌患者实施延续性护理,可以提高生活质量,减轻心理症状,降低尿失禁发生率,改善患者的预后。     

腹腔镜前列腺癌根治术与开放手术的比较

目的 通过腹腔镜前列腺癌根治术(LRP)和开放前列腺癌根治术(ORP)的对照研究,评价LRP在临床的应用价值.方法 收集前列腺癌根治术病例44例,其中行LRP15例、ORP 29例.比较两组间手术疗效及安全性.结果 LRP组15例,成功完成14例.患者平均手术时间为(271.21±109.20)min,平均出血量(395.57±310.07)ml.ORP组29例患者平均手术时间(154.73±64.95) min,平均出血量(746.62±604.55)ml.两组出血量和手术时间比较,差异均有统计学意义(t分别=4.39、2.04,P均＜0.05);而两组住院时间和术后血清前列腺特异抗原(PSA)比较,差异均无统计学意义(t分别=1.98、1.27,P均＞0.05).结论 LRP在出血的控制方面优于ORP,LRP是安全可行的.     

腹腔镜前列腺癌根治术的护理体会

目的探讨腹腔镜前列腺癌根治术围手术期护理经验。方法总结2007年2月至2010年4月29例腹腔镜前列腺癌根治术的围手术期护理措施。结果本组手术均获成功,术后恢复顺利,并发尿失禁3例,所有患者均痊愈出院,平均住院15 d。结论腹腔镜前列腺癌根治术的护理措施有别与其它腹腔镜下手术的常规护理,探讨和总结腹腔镜前列腺癌手术的多种形式的护理措施,有助于腹腔镜前列腺癌根治术患者的恢复。     

Postoperative Mycoplasma hominis infection after robot‐assisted laparoscopic radical prostatectomy: A case report

A 59‐year‐old man developed a high fever, elevated white blood cell count, elevated C‐reactive protein level, and perineal pain 5 days after robot‐assisted laparoscopic radical prostatectomy. Treatment with cefmetazole was ineffective. A urine specimen was submitted for culture on postoperative day 7, and Mycoplasma hominis (M. hominis) was detected 1 week later. Cefmetazole was therefore switched to quinolone. The clinical symptoms and laboratory data immediately showed marked improvement. M. hominis has been shown to inhabit the genitourinary tract. Although it is considered to induce urethritis, its pathogenicity in healthy male subjects has not been investigated. M. hominis is difficult to detect and is resistant to β‐lactams because it lacks a cell wall. Urine culture sometimes results in false‐negative results. In cases where empirical therapy for postoperative infection is ineffective, surgeons should recognize the possibility of M. hominis involvement and consider changing the antibiotic used.     

EMS-initiated refusal of transport: the current state of affairs

The objectives of this study were 1) to determine the number and characteristics of emergency medical services (EMS) agencies within the 200 largest US cities that sanction EMS-initiated refusal of transport; and 2) to determine the extent of no-cost alternative transport mechanisms among those agencies that allow EMS-initiated refusal of transport. EMS agencies located within the 200 largest US cities were contacted via telephone and surveyed as to whether their agency sanctioned EMS-initiated refusal of transport (EMS-IROT). Agencies with a policy were further questioned regarding its components and usage patterns. The telephone survey contacted 100% (200) of the target population. Currently, 7.0% (14) of EMS agencies have EMS-IROT protocols, with 64% (9) of those requiring direct medical oversight. Five (2.5%) of the 200 agencies sanctioned EMS-IROT without requiring online medical approval. Average annual call volume of the five agencies not requiring direct medical oversight was 70,800; their EMS-IROT protocols have been in existence a mean of 19.8 years. None of these agencies had a no-cost alternative transport mechanism. Three (1.5%) agencies terminated EMS-IROT protocols in the past. EMS-initiated refusal of transport continues to be a rare entity among US EMS agencies. Those that do not require direct medical oversight tend to have well-established programs, though no agency offered a formal no-cost alternative transport mechanism.     

机器人辅助腹腔镜前列腺癌根治术的手术配合

目的探讨机器人辅助腹腔镜前列腺癌根治术的护理配合,提高护士的手术配合质量。方法对国内首次开展的16例机器人辅助腹腔镜前列腺癌根治手术配合进行总结分析。结果16例机器人辅助腹腔镜前列腺根治术顺利完成,无一例中转开腹。结论充分的术前准备和熟练的手术配合是机器人手术成功的重要因素。     

Transrectal ultrasonographically assisted radical retropubic prostatectomy.

Radical prostatectomy is associated with difficulty in determining the division site of the urethra adjacent to the apical region of the prostate. We present the results of a feasibility clinical trial in three patients to determine whether intraoperative transrectal ultrasonography may assist during radical retropubic prostatectomy. Using this technique the apex is readily identified and a detailed view of the urethral stump could be obtained. In one case residual apical tissue was identified and excised. The creation of the vesicourethral anastomosis was documented and its water tightness was demonstrated. We conclude that transrectal ultrasonography can be performed during radical retropubic prostatectomy and may be helpful in selected cases.     

Development of prophylactic AIDS vaccines: the current state of affairs

Despite an urgent need for a prophylactic vaccine against human immunodeficiency virus (HIV) type 1, progress in this area has been slow. The initial euphoria after identifying and sequencing the causative agent of the acquited immunodeficiency syndrome (AIDS) was followed by a realization that for HIV, traditional vaccine approaches would not be applicable. Frustrations with the induction of neutralizing antibodies led to the development of new vaccine focusing on the induction of cytotoxic T-lymphocytes (CTLs). While CTLs cannot confer sterilizing immunity, there are encouraging data from animal models suggesting that these vaccines may increase the threshold of infection and delay the onset of AIDS in humans. The CTL hypothesis and the possibility that some non-neutralizing antibodies may assist CTLs in the prophylaxis against HIV have yet to be tested in phase III efficacy trials.     

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.     

腹腔镜前列腺癌根治术与开放术式的疗效比较Meta分析

目的利用Meta分析的方法,评价腹腔镜前列腺癌根治术(LRP)与开放前列腺癌根治术(ORP)两种手术方式治疗局限性前列腺癌的疗效。方法选取发表于1990～2011年的文献,对比LRP与ORP两种术式治疗局限性前列腺癌的随机对照试验和临床对照试验,并应用Meta分析评价手术时间、术中出血量、输血情况、切缘阳性率、术后尿道狭窄发生率、术后控尿、术后勃起功能等相关指标。结果本篇Meta分析,共分析了14篇临床同期对照试验。共纳入了9006例患者,其中行LRP3261例患者,行ORP5745例患者。对于切缘阳性的发生率,腹腔镜与ORP之间无统计学差异(OR0.88,95%CI0.77～1.01,P=0.06);LRP手术时间长于开放手术(WMD60.25min,95%CI30.83～89.68min,P<0.0001),差异具有统计学意义。LRP术中出血量小于ORP(WMD-686.61ml,95%CI-1101.49～-271.72ml,P=0.001),差异具有统计学意义。LRP患者输血率低于ORP(OR0.17,95%CI0.10～0.29,P<0.0001),差异具有统计学意义。LRP术后尿道狭窄的发生率低于ORP(OR0.32,95%CI0.14～0.71,P=0.005),差异具有统计学意义。LRP的术后一年控尿率与ORP无统计学差异(OR1.29,95%CI0.88～1.89,P=0.20)。术中保留双侧性神经的患者的术后一年勃起功能,LRP优于ORP(OR2.23,95%CI1.48～3.36,P=0.0001)。结论对于局限性前列腺癌,腹腔镜与ORP的切缘阳性发生率和术后一年控尿功能相似。LRP的手术时间长于ORP,但术中出血量少于ORP,患者输血率小于ORP,且术后尿道狭窄发生率和术后一年阳痿发生率小于ORP。     

腹腔镜下前列腺癌根治术的围手术期护理

目的探讨腹腔镜前列腺癌根治术的围手术期护理。方法4例采用经腹腔途经,7例采用经腹膜外途经,手术切除前列腺、精囊、输精管壶腹,行膀胱尿道吻合。采取心理护理、肠道准备、生命体征监测、引流管护理、活动训练、饮食控制等围手术期护理。结果全体患者术后恢复顺利,无并发症发生。结论该围手术期系统护理策略对腹腔镜下前列腺癌根治术是一种有效的护理方法。     

Clinical outcomes and problems in laparoscopic radical prostatectomy

We evaluated the clinical outcome and problem of laparoscopic radical prostatectomy (LRP) for 115 prostate cancer patients. Mean (+/- SD) operative time was 294 +/- 57.5 min. and mean blood loss was 409.5 +/- 336.4 g. Mean duration of urethral catheter indwelling was 4 +/- 4.9 days and mean postoperative hospital stay was 8 +/- 4.6 days. Fifty one and 83% of the patients recovered urinary continence one month and 3 months after surgery in the latest procedure, respectively. Positive surgical margin was seen in 18 patients (15.7%) in total, but in 6 patients (6.6%) with pT2 > or = disease. Chemical relapse was seen in 14 patients (14.4%). Although oncological results of LRP are compatible to those of RRP, delay of early recovery of urinary continence is still the problem.     

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.