Transumbilical single-port laparoscopic partial nephrectomy

OBJECTIVE

To present the initial experience with laparoscopic partial nephrectomy (LPN) performed through a transumbilical single port.

PATIENTS AND METHODS

Between November 2007 and April 2008, five selected patients underwent single‐port LPN (SPLPN) for renal tumours. All procedures were performed through a single intraumbilical multichannel laparoscopic port. A 2‐mm grasper was inserted through a 2‐mm Veres needle‐port in the anterior axillary line to aid in tissue retraction and sutured renal reconstruction. The technique of standard multiport LPN was replicated, with the renal hilum clamped.

RESULTS

SPLPN was successfully completed in four patients, while an additional 5‐mm port was required in one patient. The median (range) tumour size was 3 (1–5.9) cm. The median (range) operating time was 270 (240–345) min and the estimated blood loss was 150 (100–600) mL. The median (range) warm ischaemia time was 20 (11–29) min. The median (range) length of the umbilical incision was 2.5 (2.5–4) cm. The median (range) hospital stay was 3(3–22) days. There were no intraoperative complications. All surgical margins were negative for tumour. There were no postoperative complications in four patients. One patient had postoperative bleeding and pulmonary embolism.

CONCLUSIONS

SPLPN is technically feasible, albeit more challenging than conventional LPN. Proper case selection is essential. Advances in single‐port specific instrumentation are needed before these procedures can become a part of mainstream urological laparoscopy.     

耻骨上经膀胱单孔机器人辅助前列腺癌根治术单中心结果初步分析

目的:探讨耻骨上经膀胱单孔机器人辅助前列腺癌根治术（SPSV-RARP）的临床效果并初步评估21例早期前列腺癌患者术后尿控情况。方法:回顾性分析2019年2—12月复旦大学附属中山医院采取SPSV-RARP治疗21例早期前列腺癌患者(cT₁N₀M₀～cT_2cN₀M₀)的临床资料。患者中位年龄为70岁,前列腺体积中位数为29.55 mL,术前前列腺特异性抗原（PSA）中位数为9.82 ng/mL。SPSV-RARP手术方式采用单切口进行,建立手术路径后,在机器人辅助腹腔镜下经膀胱完成前列腺根治性切除术,通过膀胱切口取出标本。记录患者围手术期情况并随访患者术后PSA及尿控情况。结果:21例患者行SPSV-RARP均顺利完成。中位手术时间为70 min,术中出血量中位数为95 mL,术后Gleason评分中位数为7分。患者切缘阳性率0,术后1个月PSA值均<0.02 ng/mL。21例患者术后拔除导尿管的中位时间为7 d。21例患者中,术后1、4、12和2...     

Robotic simple prostatectomy: Initial single-center experience in Taiwan

ObjectiveFor patients with symptomatic large volume benign prostate hyperplasia, open simple prostatectomy has traditionally been the treatment of choice but laparoscopic simple prostatectomy (LSP) has become an effective surgical option. Since the first case of LSP was described in 2002, surgeons have continued to expand the use of minimally invasive surgery. In 2008, the first case of robotic simple prostatectomy (RSP) was reported. We herein report our initial experience with robotic simple prostatectomy.Materials and methodsWe performed retropubic robotic simple prostatectomy using a transperitoneal approach in 10 patients. All of them had significant symptomatic prostate enlargement confirmed by abdominal or transrectal ultrasound (mean 138.2 mL). Demographic data, perioperative outcomes, and functional outcomes were recorded.ResultsThe median age of patients was 68 years (range 60–76 years). The median International Prostate Symptom Score at baseline was 24 (range 18–34). The median operation time was 150 minutes (range 130–180 minutes). The median estimated blood loss was 100 mL (range 50–850 mL). Intraoperative blood transfusion was required in one patient (10%). The median resected prostate weight was 77.5 g (range 60–120 g). The median hospital stay was 5 days (range 3–5 days). The median urethral catheterization was 12 days (range 9–14 days). All of these patients gained significant improvement in maximum urine flow rate (preoperative vs. postoperative 9.8 mL/min vs. 21.5 mL/min, p = 0.001) and postvoid residual urine (preoperative vs. postoperative 125 mL vs. 10 mL, p = 0.001).ConclusionRobotic simple prostatectomy is a feasible alternative for a greatly enlarged prostate gland with acceptable complications.     

腹膜外入路经脐单孔腹腔镜下前列腺癌根治术11例报告

目的 探讨使用自制多通道套管经脐切口行单孔腹腔镜下前列腺根治性切除术的方法及初步疗效.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.经脐3 cm切口,腹膜前置入自制多通道套管,行单孔腹腔镜下双侧闭孔淋巴结清扫、前列腺根治性切除、膀胱尿道吻合术.膀胱尿道吻合采用活结套结连续缝合法完成.结果 1例增加1个套管,其余10例手术均顺利完成,无中转常规腹腔镜手术或开放手术.平均手术时间256(195～315)min,平均出血量90(20～180)ml,平均术后住院时间15.4(13～24)d,术后12 d拔除尿管.无术中并发症.术后1例出现膀胱尿道吻合口漏、2例出现淋巴漏、1例出现泌尿系感染,均经保守治疗治愈.病理报告11例手术标本切缘均阴性,清扫淋巴结阴性.患者平均随访7(3～11)个月,无肿瘤生化复发.结论 单孔腹腔镜下前列腺根治性切除术技术上可行,具有美观、微创、并发症少的特点,具有良好的短期功能和肿瘤控制效果,中长期疗效需进一步随诊观察.

Abstract：

Objective To present our initial experience in laparoscopic radical prostatectomy performed through an umbilical incision using a home-made multichannel port. Methods From August 2009 to March 2010, we performed single-port laparoscopic radical prostatectomy in 11 patients with localized prostate cancer. A home-made multichannel port was inserted extraperitoneally through a 3-cm umbilical incision. The single port extraperitoneal procedures included obturator fossa lymphadenectomy, radical prostatectomy and urethro-vesical anastomosis, while the urethro-vesical anastomosis was performed by a slip-knot running suture technique. Data were collected and analyzed prospectively. Results All cases were completed successfully, without conversion to a standard laparoscopic approach or open surgery except adding an additional port in one case. The average operative time was 256 minutes (range195-315), and the mean blood loss was 90 ml (range 20- 180), without any blood transfusion. The postoperative hospital stay was 15.4 days (range13- 24), and the Foley catheter was removed 12 days after surgery. No intraoperative complications occurred. One patient developed a vesico-rethralanastomosis leakage, 2 had lymphatic leakage and 1 had urinary tract infection,all of the cases were managed successfully with conservative treatment. Histopathological results showed negative surgical margine and negative lymph node dissection. All patients had no biochemical relapse after an average follow-up of 7 months. Conclusions Single-port laparoscopic radical prosta tectomy is feasible, cosmetic and minimally invasive with a low complication rate and good short-term outcome. Additional investigation is needed to evaluate the long-term safety and oncologic adequacy of this new approach.     

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。     

‘LESS’ radical prostatectomy: a pilot feasibility study with a personal original technique

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoendoscopic single‐site surgery (LESS) provides the ability to perform major surgery with minimal incisions and nearly scar‐free results. A pure single port laparoscopic radical prostatectomy has been previously described as a feasible but challenging procedure with a high complications’ rate. We describe a modification of the single‐port laparoscopic radical prostatectomy, using a periumbilical multichannel port plus a second port placed in the left iliac fossa with the aim of having an adequate working angle during the most critical steps of the procedure. This minimally invasive technique is a safe procedure and appears to be a good compromise between a pure single multichannel port and a standard multitrocar laparoscopic approach.

OBJECTIVE

We evaluated the feasibility and the potential advantages of a modification of the single‐port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure.

PATIENTS AND METHODS

Between March and September 2009 we operated on five patients with early‐stage prostate cancer (T1c) and a normal body mass index (<25). The procedure was carried out with a specially‐designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy.

RESULTS

All cases were completed successfully in a mean operative time of 225 minutes (range 210–250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow‐up of 4 months (range 1–7) all patients have an undetectable prostate‐specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil.

CONCLUSION

Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.     

Midterm outcomes of four-port extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer within Asian population

ObjectiveAsian patients tend to have higher stage prostate cancer at diagnosis compared with patients of other races. This article aims to investigate the use of four-port extraperitoneal laparoscopic radical prostatectomy (EPLRP) as the first step in a multimodality treatment strategy for Asian patients with high-risk prostate cancer (HRPC).Materials and methodsA cohort of 202 patients underwent EPLRP between January 2006 to January 2016, of whom 122 (60.3%) had HRPC as defined by D'Amico classification: clinical T stage ≥ cT2c or PSA level ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). All patients underwent proper preoperative staging. The median age was 68 years (48–82), PSA level 17.8 ng/mL (3.3–191.1), and biopsy Gleason sum 7 (6–10). All patients underwent pelvic lymphadenectomy, and some underwent neurovascular bundle preservation according to their risk category.ResultsPerioperative outcomes included a median operative time of 185 min (65–380), total blood loss 150 ml (30–500), postoperative hospitalization 10 days (6–25), and urethral catheterization time 7 days (4–22). No patient was converted to open surgery. Median specimen weight was 42 g (19–124), lymph node yield was 10 (0–35) with 11.5% positivity and a positive surgical resection margin rate of 28.7%. The median follow-up period was 37 months (6–129). 96.7% of patients achieved continence and 53.8% of the 39 potent patients prior to surgery maintained their sexual potency at one year after EPLRP. The 5-year cancer-specific, overall, and biochemical recurrence-free survival rates were 98.8%, 92.2%, and 68.7%, respectively.ConclusionExtraperitoneal laparoscopic radical prostatectomy has low morbidity, and can provide fair functional and oncological outcomes as the first step of a multimodality treatment strategy for high-risk prostate cancer in Asian.     

Laparoendoscopic single‐site urological surgery: Initial experience in Japan

The objective of this paper is to report our initial experience in laparoendoscopic single‐site surgery (LESS). One patient underwent LESS varicocelectomy and another patient underwent LESS pyeloplasty. The Triport was inserted into the abdomen through the umbilical incision. In the varicocelectomy, testicular vessels were coagulated by a vessel‐sealing system, and transected. In the pyeloplasty, a 2‐mm needlescopic port was added to facilitate the procedure, and a dismembered procedure was performed. Total operative duration was 60 min for the varicocelectomy and 240 min for the pyeloplasty. Blood loss was minimal and no perioperative complications occurred. At the 3‐month follow up, no postoperative complications were observed and there was no complaint of pain. LESS varicocelectomy and pyeloplasty were successfully performed with excellent cosmetic results and no complications.     

Early experience on simultaneous mastectomy and video‐assisted thoracoscopic surgery lobectomy via mastectomy incision

Aim: To assess the feasibility of simultaneous video‐assisted thoracoscopic surgery (VATS) lobectomy and mastectomy via the same incision in patients with synchronous primary carcinoma of the ipsilateral breast and lung. Methods: The patient was first positioned supine and modified radical mastectomy for the breast carcinoma was carried out in the standard way. After that, the mastectomy wound was partially closed and the patient was then turned into a full right decubitus position. Camera and instrument ports were inserted and a utility thoracotomy was made through the mastectomy wound. VATS lobectomy was then carried out. Results: From December 2007 to December 2008, three patients with synchronous primary breast and lung tumour received simultaneous mastectomy and VATS lobectomy through a single mastectomy incision in our institute. There was no operation‐related mortality. The median operation time was 253 min (range 246–345 min) and the median blood loss was 250 mL (range 110–300 mL). All except one patient had uneventful postoperative recovery and deep vein thrombosis was noted in one patient. Conclusion: Simultaneous lobectomy through the mastectomy incision is a safe and feasible treatment option for ipsilateral pulmonary and breast lesion with encouraging outcome.     

Single‐incision laparoscopic colonic surgery

Aim SILS is an area of growing interest in colorectal surgery. We report our preliminary experience of 13 consecutively selected patients undergoing colonic surgery using SILS. Method From July 2009 to January 2010, 13 patients (five men) of median age 56 (23–82) years and a body mass index (BMI) of 23.5 (18–30) kg/m² underwent colonic surgery. Procedures included subtotal colectomy (1), ileocolic resection (2), right colectomy (4) and sigmoidectomy for benign disease (6). Three instruments (including camera) were introduced through a single 2.5‐cm port (SILS? Port Multiple Instrument Access Port; Covidien Inc., Norwalk, Connecticut, USA) inserted at the umbilicus. Results The median operating time was 150 (100–240) min, and the median size of the umbilical port incision was 32 (25–50) mm. There was no postoperative mortality and morbidity, and the median hospital stay was 6 (4–10) days. The cosmetic result was judged to be excellent in 12 of 13 patients who felt it to be better than expected. Conclusion This preliminary experience shows that SILS is technically feasible and safe for colonic resection.     

Robotic Single-site Hysterectomy in Low Risk Endometrial Cancer: A Pilot Study

Background

To evaluate the feasibility and the safety of robotic single-site hysterectomy (RSSH) in low risk early endometrial cancer.

Methods

Patients with clinical low risk early endometrial cancer were enrolled onto a prospective cohort trial. All surgical procedures were performed through a single 2–2.5 cm umbilical incision, with a multichannel system consisting of a five-lumen port providing access for two single-site instruments (da Vinci Si Surgical System, Intuitive Surgical, Sunnyvale, CA), the 8.5 mm 3D HD endoscope, a 5/10 mm accessory port, and an insufflation adaptor.

Results

Between December 2011 and June 2012, a total of 17 patients were included in our pilot study. The median age of the patients was 64 years (range, 42–84 years), and median body mass index was 26.6 kg/m² (range, 18–52 kg/m²). One patient was excluded from the study as a result of pelvic metastasis during inspection of abdominal cavity, and another patient was converted to vaginal surgery as a result of problems of hypercapnia. The median docking time, console time, and total operative time was 8 min (range, 5–14 min), 48 min (range, 45–51 min), and 90 min (range, 70–147 min), respectively. The median blood loss was 75 mL (range, 50–150 mL). No laparoscopy/laparotomy conversion was registered. The median time to discharge was 2 days (range, 1–3 days). Neither intraoperative nor postoperative complications occurred. At a median of 7.5 months’ follow-up, all patients were disease-free.

Conclusions

RSSH is technically feasible in patients affected by low risk early endometrial cancer. Additional studies with gynecologic oncologic cases should be performed to explore the possible benefits of RSSH.     

经脐单孔腹腔镜肾输尿管全长切除术8例分析

目的观察经脐单孔腹腔镜肾输尿管全长切除术治疗肾盂癌或输尿管癌的安全性及可行性。方法回顾性分析2011年4～10月在本院入住的肾盂癌或输尿管癌行经脐单孔腹腔镜肾输尿管全长切除术8例患者的临床资料。术中先行经尿道电切法分离壁内段输尿管。后采用脐周患侧弧形切口,用自制＂两环一套法＂建立单孔腹腔镜通道,行经脐单孔腹腔镜肾输尿管全长切除术。结果全部手术顺利,手术平均时间（179±18）min,单孔腹腔镜部分平均手术时间（146±17）min,术中平均出血量为（80±51）mL。全部患者术中未输血、无术中并发症发生、无中转开放手术。患者术后72h内排气。3～5d拔除引流管。术后1周拔除导尿管。术后住院天数为8～11d。随访3～9月,均未见肿瘤复发和转移。结论经脐单孔腹腔镜肾输尿管全长切除术安全可行,美容效果比传统腹腔镜更好。自制＂两环一套法＂建立单孔腹腔镜通道制作简单,操作方便,成本低,能够完成单孔腹腔镜肾输尿管全长切除术。     

Emergency laparoscopic surgery for complicated diverticular disease

Objective The aim of this study was to analyse the outcome of emergency laparoscopic surgical management of complicated diverticular disease. Method A prospectively collected electronic database of all colorectal laparoscopic procedures between April 2001 and September 2007 has been used to identify outcomes in patients presenting with complicated diverticular disease. Results Sixty‐six patients (28 men), median age 69 years (23–95), ASA grade II (12), III (38), IV (16) have undergone emergency surgery for complicated diverticulitis – Hinchey grades I (27), II (29), III (7) and diverticular bleeding (3) over a 6½‐year period: 43 high anterior resections, 17 Hartmann’s resections and seven low anterior resections. Diverticular fistulas were seen in 16 patients: colovaginal (7), colovesical (2), colo‐fallopian (4), entero‐colic (3). The median operation time was 110 min (45–195 min). There was one conversion to open surgery. Postoperative analgesia was provided by intravenous Paracetamol in 33 patients (50%), patient‐controlled analgesia in 24 (36%), oral Paracetamol and Oramorph (12%) and epidural opioid infusion (1.5%). The median time to normal diet was 24 h (4 h–6 days) and median hospital stay 5 days (2–30). There were two deaths (3.3%); anastomotic leak, ventricular fibrillation (VF) cardiac arrest. Other complications included: wound infection eight (12%), anastomotic leak four (8%), port‐site hernia one and one case of Clostridium difficile colitis requiring colectomy. There were five (7.5%) returns to theatre and two readmissions (3%). Conclusion Laparoscopic resectional surgery in complicated diverticular disease is a feasible, safe and a largely predictable operation that allows for early hospital discharge and, in our opinion, improved patient care. We are encouraged to continue to offer our patients the option of an emergency laparoscopic resection.     

Intrathoracic esophagojejunostomy using OrVil? for gastric adenocarcinoma involving the esophagus

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrVil™.METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrVil™was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009, we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus.RESULTS: The median operation time was 314 min (range; 210-367 min), and median blood loss was 210 mL (range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3 (range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. The median hospital stay was 16 d (range: 15-20 d). The median length of esophageal involvement was 14 mm (range: 6-48 mm) and that of the resected esophagus was 40 mm (range: 35-55 mm); all resected specimens had tumor-free margins.CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.     

Intrathoracic esophagojejunostomy using OrVil~(TM) for gastric adenocarcinoma involving the esophagus

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrV il~(TM). METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrV il~(TM)was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009,we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus. RESULTS: The median operation time was 314 min(range; 210-367 min), and median blood loss was 210 mL(range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3(range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. Themedian hospital stay was 16 d(range: 15-20 d). The median length of esophageal involvement was 14 mm(range: 6-48 mm) and that of the resected esophagus was 40 mm(range: 35-55 mm); all resected specimens had tumor-free margins.CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.     

非气腹腹腔镜下前列腺癌根治术11例报告

目的：探讨非气腹腹腔镜下前列腺癌根治术的可行性及疗效。方法2012年7月～2013年6月,行非气腹腹腔镜下前列腺癌根治术11例。前列腺特异抗原（PSA）（19．6±17．2） ng/ml,前列腺体积33～78 ml,平均41 ml。临床分期cT1期3例,cT2期6例,cT3期2例。取耻骨上正中切口3～5 cm,用手指钝性分离膀胱前间隙。在腹腔镜或示指引导下于双侧麦氏点下2 cm与脐下弧形穿出3个操作通道。应用悬吊器械提拉下腹壁创造操作的空间,30°腹腔镜通过脐部的通道进入,术者通过两侧的通道及下腹部的小切口进入器械操作。手术操作与传统的腹腔镜下前列腺癌根治术相同。结果11例手术顺利,手术时间（227±61） min,术中出血量（360±101） ml,无直肠损伤等严重并发症。术后病理均为前列腺腺癌,无切缘阳性。随访1～11个月,平均4个月,排尿通畅,无尿失禁。 PSA 0～0．21 ng/ml,平均0．11 ng/ml。结论非气腹腹腔镜下前列腺癌根治术微创、安全、有效。     

Single port laparoscopic right colonic resection using a 'vessel-first' approach

Aim Single port laparoscopic colorectal surgery (SPLC), performed through a single incision of ≤ 3 cm, has been shown to be feasible. This study aimed to assess its safety and efficacy when used as the method of choice for right hemicolectomy. Method A prospective study was carried out of patients undergoing right hemicolectomy using a single port laparoscopic technique. They were compared with a historical series of patients undergoing right hemicolectomy using a multiport laparoscopic technique. Between December 2009 and September 2010, single port surgery replaced conventional laparoscopic colorectal surgery (LCS) for radical medial to lateral right hemicolectomy performed by a single surgeon. Histology, length of hospital stay, complications, conversions and readmissions were recorded. Results Fourteen patients were treated using single port laparoscopic surgery (SPLC): 10 for carcinoma (Dukes A1, B6, C3) and four for Crohn’s disease. Twelve patients were treated using multiport laparoscopic colorectal surgery (LCS): eight for carcinoma (Dukes B4, C3, Carcinoid 1), three for Crohn’s disease and one for adenoma. The median (interquartile range) operative time for the SPLC group was 120 (90–135) min and for the LCS group was 135 (116–150) min. The median (interquartile range) length of hospital stay was 3.5 (2.0–5.0) days for the SPLC group and for the LCS group was 4.0 (3.8–7.0) days. The median (interquartile range) number of lymph nodes removed for SPLC patients was 14.5 (9.8–19.5) and for the LCS patients was 14.5 (13.0–19.5). There were no conversions, no complications and no readmissions in either group. Conclusion These data confirm the feasibility of the technique. Furthermore they suggest that it is safe and efficacious.     

Use of a balloon catheter in management of the pelvic space following laparoscopic abdominoperineal excision

Aim Management of the pelvic space following laparoscopic abdominoperineal excision remains controversial. We describe a simple technique for obliteration of the pelvic space after laparoscopic abdominoperineal excision. Method Pneumoperitoneum was re‐established after completion of the operative procedure and a Foley catheter Ch. 24 was inserted through the right lower port under direct vision. The balloon of the catheter, placed in the presacral space, was filled with 50 ml of sterile saline and connected to passive drainage. The catheter was removed 10 days postoperatively. Results This technique was used in 15 patients with the median age of 74 years (range 63–86). Eleven patients were treated with preoperative chemoradiotherapy. The median length of hospital stay was 9 days (range 5–11). Two patients (13.3%) treated with chemoradiotherapy developed a superficial perineal wound infection and four patients (26.6%) had a deep pelvic abscess, which required surgical drainage. The median time of perineal wound healing was 3 months (range 2–8). The median follow‐up time was 36 months (range18–60). None of the patients developed perineal hernia or intestinal obstruction in the follow‐up period. One patient underwent small bowel resection due to stenosis caused by radiation enteritis. There was no local recurrence, but two patients developed distant metastases after 12 months. Conclusion Our results suggest that filling the pelvic cavity with a balloon catheter for 10 days results in the creation of a thin, fibrotic peritoneal layer which keeps the small intestine out of the pelvis and prevents loops of intestine adhering in the pelvic cavity.     

SERUM SEX HORMONES AND THE 20‐YEAR RISK OF LOWER URINARY TRACT SYMPTOMS IN COMMUNITY‐DWELLING OLD MEN

OBJECTIVE

To determine the pathological characteristics of radical prostatectomy specimens with respect to index and secondary lesions.

METHODS

A total of 100 consecutive radical prostatectomy specimens examined at a single hospital were assessed. Patients undergoing salvage prostatectomy or those who had received neoadjuvant hormonal manipulation were excluded. Preoperative data and the number, volume and Gleason grade of each tumour focus were recorded. Criteria used to define a clinically significant lesion were tumour volume ≥0.5 mL and/or Gleason pattern 4 or 5 and/or extra‐capsular disease.

RESULTS

Overall, 374 foci were examined. The median number of tumours per patient was 3.5 (range 1–15). The overall median tumour volume was 1.4 mL (range 0.1–18.2), the median volume of the largest (index) tumour was 0.95 mL (range 0.1–18.2) and the median volume of the largest secondary tumour was 0.2 mL (range 0.05–1.7). There were no patients in whom the index lesion was insignificant and secondary tumours were significant (by grade or extra‐capsular disease). Seventy‐seven fulfilled the clinical parameters of low‐to‐intermediate‐risk disease. If focal therapy can be delivered with the aim of ablating all clinically significant disease, with untreated areas harbouring no cancer or clinically insignificant disease, between 58.5 and 67.5% might have been suitable for such a strategy.

CONCLUSIONS

The proportion of men with low‐to‐intermediate‐risk prostate cancer who may potentially be suitable for a focal therapy approach is unknown. The key question is whether the volume of individual lesions points to clinically significant cancer and whether ablation of these lesions alone would lead to cancer control. This research question is currently undergoing evaluation within a prospective clinical trial.     

增加辅助孔的经脐单孔腹腔镜巨大卵巢囊肿手术

目的探讨改良经脐单孔腹腔镜治疗巨大(>10 cm)卵巢囊肿的安全性。方法2018年6月~2019年12月,行改良经脐单孔腹腔镜巨大卵巢囊肿手术57例,经脐开放式入路,切口2~2.5 cm,置入切口保护套及单孔Port,左下腹置5 mm trocar和器械协助。行卵巢囊肿剥除18例,附件切除25例,全子宫+单/双附件切除10例,全子宫+双附件+大网膜+盆腔淋巴结切除4例(其中2例加行阑尾切除术)。结果3例因严重粘连加右下腹5 mm trocar双人配合操作,其余54例均单人操作行增加一个辅助孔的经脐单孔腹腔镜手术,无中转开腹。术后随访1~18个月,平均12.3月,1例黏液性囊腺瘤剥除术后6个月复发。结论增加辅助孔的经脐单孔腹腔镜技术治疗巨大卵巢囊肿具有良好的器械操控性,可行切口保护,可安全、快速取出标本,具有一定的临床推广价值。