達文西機器手臂輔助攝護腺根除術-Hood技術

陳子双¹、王弘仁¹

¹高雄長庚紀念醫院 泌尿科

Robot-assisted radical prostatectomy - Hood Technique

Tzu-Shuang Chen¹, Hung-Jen Wang¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose: This study aimed to assess the feasibility and safety of the Hood technique in robot-assisted radical prostatectomy (RARP).

Materials and Methods: A retrospective analysis was conducted on the clinical data of 25 patients who underwent RARP using the Hood technique at Kaohsiung Chang Gung Memorial Hospital by one surgeon, from Jan to Oct 2023. The Hood technique was used to preserve the periurethral structures such as detrusor apron, puboprostatic ligament complex, arcus tendineus, endopelvic fascia, and pouch of Douglas. Surgical outcomes, postoperative pathology, and the use of daily pads were analyzed.

Results: The average age of the patients was 68.6 years, with an average body mass index (BMI) of 24.75 kg/m² and preoperative prostate-specific antigen (PSA) levels averaging 15.77 ng/ml (range: 3.42 to 58.68 ng/ml). All patients underwent preoperative biopsies for definitive diagnosis, with an average Gleason score of 7.3 (range: 6 to 9). Preoperative clinical staging revealed 4 cases of T2a, 13 cases of T2c, 2 cases of T3a, and 4 cases of T3b. All 25 surgeries were completed successfully without conversion to open surgery. The average duration of urethral catheterization postoperatively was 6.28 days (range: 6 to 8 days). 19 patients achieved immediate continence after catheter removal. The rate of continence was 76%, 92% and 96% at 1, 3 and 6 months postoperatively. Postoperative pathology revealed 14 cases of pT2, 8 cases of pT3a, and 3 cases of pT3b. Nine patients had positive surgical margins. Only one patient had minor complication of fever after surgery and no patients required readmission due to surgical complications.

Conclusion: The application of the Hood technique in RARP achieves favorable continence outcomes. Further studies comparing different RARP approaches is needed.