Retzius保存式腹腔鏡攝護腺根除手術
裘坤元
台中榮民總醫院 外科部 泌尿外科
Laparoscopic retzius-sparing radicalprostatectomy:
A reversed evolution from robotic-assisted radical prostatectomy
Kun-Yuan Chiu
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan.
Introduction:
Robot-assisted radical prostatectomy (RaRP) is viewed as the main surgical option in patients with localized prostate cancer. Robotic-assisted Retzius-sparing radical prostatectomy (Retzius-sparing RaRP) is also in development to achieve the trifecta (cancer free, continence and potency). For economic consideration, we modified the methodology using the same Retzius-sparing approach but with laparoscope.
Patients and Methods:
A total of 5 patients underwentRetzius-sparing LRP from May to Augustof 2015. General characters of patients, peri-operative parameters, functional and oncologic datas were collected. Patient position and trocar placement is identical with our conventional LRP. The steps of whole procedure were very similar to the method that SK Lim, et al. (BJU Int 2014; 114: 236–244) had published to describe the process of Retzius-sparing RaRP. Continence was defined as no need for pad in daily life.
Result:
The average operative time was 213 minutesand the average amount of blood loss was195 ml. Two patients received bilateral NVB preserving while the other three patients received unilateral partial preserving. Four patients got immediate continence control at the first day after Foley removal. The other one had post-operative anastomotic leakage and initial mild stress urine incontinence but got recovery in 2 weeks.
Conclusions:
At the very first time we show the Retzius-sparing LRP is a feasible option for localized prostate cancer. It might result in early continence control in our initial experience and with less economic costthan RaRPfor patients. Further long-term prospective studies are needed to define the benefits of this method.