保留 retzius 机器人辅助根治性前列腺切除术
Summary
机器人辅助的Retzius保留根治性前列腺切除术是一种能够保持尿失禁或促进大多数患者尿失禁恢复的技术。必须告知患者手术切缘阳性的风险。
Abstract
提供了保留Retzius的机器人辅助根治性前列腺切除术（RS-RARP）的技术以及在单个中心的初步经验。该技术将逐步描述，并通过视频进一步说明以增强可重复性。评估早期肿瘤学和功能结果。总共纳入77名患者，中位随访时间为11个月（范围：3-21个月）。51%的患者患有局部高风险或局部晚期前列腺癌。没有术中并发症，所有高级别并发症（2.6%）与RS-RRP同时进行的盆腔淋巴结清扫术有关。中位手术时间为160分钟（范围：122-265分钟），中位住院时间为3天（范围：3-8）。据报道，42.9% 的患者手术切缘阳性。一年生化无复发生存率为90.1%。6个月后，所有患者均处于社交状态，1年后，94.3%的患者完全进入社交状态。在至少接受单侧神经保留的性活跃患者中，43.3%能够进行。该系列强调了通过标准化技术进行RS-RRP的手术安全性，并证实了对尿失禁早期恢复的有益作用。需要告知患者手术切缘阳性的风险。
Introduction
为了治愈局部和选定的局部晚期前列腺癌病例，根治性前列腺切除术是推荐的治疗方案之一1。与开放性根治性前列腺切除术2，3 相比，微创技术（常规腹腔镜检查和机器人辅助腹腔镜检查）具有降低失血、术后疼痛和住院时间的优势。在微创技术中，机器人辅助手术结合了微创手术的优点，增加了手术器械的灵活性和移动自由度，并具有三维围手术期视觉。在资源丰富的国家，机器人辅助根治性前列腺切除术（RARP）已成为进行根治性前列腺切除术的主要模式4。
暂时性或确定性尿失禁是根治性前列腺切除术的常见副作用，无论其实施方式如何5.对于开放性（腹部）、腹腔镜和“标准”前 RARP （SA-RARP），根治性前列腺切除术采用前路入路进行，其中耻骨后 （Retzius） 空间被打开6.由于与 RARP 相关的灵活性增加，另一种解剖学方法是可能的，其中前列腺通过直肠袋或道格拉斯袋切除，如 Galfano 等人首次描述的那样7。这种后方方法使雷齐乌斯的空间完好无损（“雷齐乌斯保留的RARP”;RS-RARP）。RS-RARP 的主要优点似乎是尿失禁恢复更快、更快8.本研究旨在详细描述（如帕萨迪纳共识小组9所建议的那样）由视听材料支持的RS-RRP步骤，并报告单个中心中第一批病例的早期功能和肿瘤学结果。
Protocol
这项研究已提交给根特大学医院的地方伦理委员会，并已获得机构批准（EC UZG 2019/1506）。该研究已在比利时研究注册处注册，参考号为B670201941650。所有患者均提供了书面知情同意书。 1. 患者准备和定位 制备遵循当代国际公认的指南来诊断前列腺癌，并为根治性前列腺切除术1 设定适应症。使用多参数 MRI 进行局部分期，因为这提?…
Representative Results
所有预期寿命>10年且无麻醉禁忌症的局部或局部晚期前列腺癌患者均提供RS-RARP作为其疾病的治疗选择之一。在临床试验或挽救性根治性前列腺切除术的背景下，接受转移性前列腺癌减瘤性根治性前列腺切除术的患者未提供RS-RARP，并且优选为前部肿瘤患者提供SA-RARP。随访少于3个月的患者被排除在外。手术前，所有患者均进行了血清前列腺特异性抗原（PSA）的测量并进行了MRI检查。术前通过经直肠…
Discussion
在RS-RRP期间，整个过程是通过后端接近膀胱来执行的。因此，与SA-RARP的主要区别在于保留了Retzius的空间。保留Retzius的空间有几个解剖学优势7：首先，膀胱没有与腹壁分离，脐带没有横断。因此，膀胱保持在其解剖位置。其次，逼尿肌前围裙和耻骨前列腺韧带未横断。虽然称为耻骨前列腺韧带，但这些韧带延伸到膀胱前表面，最好称为耻骨韧带13。这些韧带是?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
这项研究没有获得任何资金。
Materials
| adhesive tape | BSNmedical | 15200028 | Tensoplast |
| assistant trocar 5mm | Aesculap | EKO17R | reusable trocar |
| assistant trocar 12mm | Conmed | iAS12-120LPi | AirSeal trocar |
| barbed wire | Covidien | VLOCM0024 | for vesico-urethral anastomosis |
| Cadiere forceps | Intuitive | 470049 | robotic instrument, grasper |
| camera 30° | Intuitive | 470027 | endoscope |
| cefazolin | Sandoz | BE217296 | Belgian farmaceutical registration |
| CO2-insufflator | Conmed | AS-iFS2 | AirSeal insufflator |
| Da Vinci Xi system | Intuitive | 600062 | robotic system |
| endobag | Covidien | 173050G | Endo Catch 10mm |
| endoscopic hem-o-lok applier | Teleflex | 544995T | to apply the locking clips |
| fenestrated bipolar forceps | Intuitive | 470205 | robotic instrument, bipolar forceps |
| Hasson cone 8mm trocar | Intuitive | 470398 | only at the camera trocar |
| heparin, low molecular weight (enoxaparin) | Sanofi | BE144347 | Belgian farmaceutical registration |
| hydrogel coated latex transurethral catheter | Bard | D226416 | Biocath |
| insufflation cable | Conmed | ASM-EVAC1 | AirSeal Tri-lumen filtered tube set |
| laparoscopic grasper | Aesculap | PO235R | Atraumatic wave grasper, double action |
| large needle driver | Intuitive | 470006 | roboic instrument, needle driver |
| locking clip | Grena | 5-13mm | Click'aVplus |
| metallic clips 5mm | Aesculap | PL453SU | for vessel ligation |
| monopolar curved scissor | Intuitive | 470179 | robotic instrument, hot shears |
| mosquito clamp | Innovia Medical | MQC2025-D | to secure bladder suspension stitch |
| natriumlaurylsulfoacetate-sorbitol-natriumcitratedihydrate clysma | Johnson & Johnson Consumer BV | RVG 05069 | Belgian farmaceutical registration |
| polyglactin 3.0 suture | Ethicon | V442H | stay suture bladder neck, subcutaneous sutures |
| polyglactin 1 suture | Ethicon | D9708 | stay suture fascia and fascia closurie |
| povidone-iodine alcoholic solution | Mylan | BE230736 | Belgian farmaceutical registration |
| robotic trocar 8mm | Intuitive | 470002 | standard length |
| Skin stapler | Covidien | 8886803712 | skin closure |
| sterile drapes robotic arms | Intuitive | 470015 | draping system robotic arms |
| suction-irrigation device | Geyi | GYSL-5X330 | laparoscopic use by assitant |
| suspension sutures | Ethicon | 628H | Ethilon 2-0 nylon suture |
| thrombo-embolus deterrent stockings | Covidien | 7203 | T.E.D. stockings |
| warming blanket device | 3M | 54200 | Bear Hugger |
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Citazione di questo articolo
Lumen, N., Lambert, E., Poelaert, F., Wirtz, M., Verbeke, S., Van Praet, C. Retzius-Sparing Robot-Assisted Radical Prostatectomy. J. Vis. Exp. (183), e63592, doi:10.3791/63592 (2022).