电切镜辅助腹腔镜前列腺癌根治术的临床初探
王军刘雍
威海市立医院泌尿科
Clinical preliminary study of resectoscope-assisted laparoscopic radical prostatectomy
WANG Jun LIU Yong
Department of Urology, WeihaiMunicipal Hospital, Weihai 264200, China
Purpose: In order to improve the outcomes of traditional laparoscopic radical prostatectomy, based on our previous study on both animal and anatomicalhuman body, we started a new surgery procedure by combining transurethral resectoscope with laparoscopic radical prostatectomy, and evaluated the efficiency and practicality of the new method.
Patients and Methods:A retrospective analysis of clinical records
(from August 2017 to June 2018) of 12 patients with prostatic cancer (stage T2) who were treated withresectocscope-assisted laparoscopic radical prostaetctomy. The average age of the patients was 68 (range, 49 ~ 76) years. All surgeries wereperformed by one surgeon.
The key points of new surgery procedure included the following steps: 1) using a button electrode to perform an annular incision to the urethra at the distal end of the seminal caruncle;2) using a ring electrode to peel downward and backwardtill the apex of the prostate and the adipose tissue in front of the rectum were exposed;
3) replacingthe ring electrode with a spherical electrode, continue to peel along the base of the prostate at the 6 o’clock position until bilateral seminal vesicles were exposed,
4) continue to peel off the two sides of the prostate and stopped at 12 o’clock position.
5)electroexcise with the button electrode at the neck of bladder, approaching the free surface of the seminal vesicle, and cut both seminal ducts. 6) Finally, laparoscopic radical prostatectomy was taken and the prostate was complete resected in the prostatic fascia.
Theoperation time, nerves preservation , blood loss, duration of hospitalization, positive margin, tumor markers test, and incontinencewere evaluated.
Results: Surgery was successful in all cases.
Conclusions: Resectocscope-assisted laparoscopic radical prostaetctomyenable surgeon to perform surgery with a more clear exposure of tissue structure and bigger resection field, so the surgery duration is shorter and complications are less. The new method allows a complete resection of prostate gland within Fascia, minimizes damage to surrounding tissues, preserveslonger and functional urethra and NVB.
Resectocscope-assisted laparoscopic radical prostaetctomy is a safe, and feasible method in the treatment of prostatic cancer.
Key words: laparoscopic；resectoscope；prostatic cancer