傳統腹腔鏡及機器手臂輔助根除性攝護腺切除術-馬偕醫院經驗
詹勤1、林文榮1,2、邱文祥1,2,3、張奐光1,2、陳建志1,2、許炯明1,2、楊志東1,2、林文州1,2
1馬偕紀念醫院 泌尿科；2馬偕醫學院；3國立陽明大學醫學院
Laparoscopic and Robotic assisted radical prostatectomy: Experience in Mackey Memorial Hospital
Chin Chan1, Wun-Rong Lin1,2, Allen W. Chiu1,2,3, Huang-Kuang Chang1,2, Marcelo Chen1,2, Jong-Ming Hsu1,2, Stone Yang1,2, Wen-Chou Lin1,2
1 Department of Urology, Mackay Memorial Hospital
2 Department of Medicine, Mackay Medical College
3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
Purpose: To present our 10-year experience in laparoscopic radical prostatectomy (LRP) with covert to robotic-assisted laparoscopic radical prostatectomy (RALP), performed in median volume cases by single-primary surgeon.
Materials and Methods: We retrospectively reviewed 140 patients with prostate cancer underwent LRP (100 patients) and RALP (40 patients) between May 2005 and May 2015. Preoperative parameters included age, body mass index, serum prostate specific antigen (PSA). Operative course parameters included the operating time, estimated blood loss, intraoperative blood transfusion, conversion to open surgery, complications. Pathological stage, specimen Gleason score, surgical margin status and postoperative PSA were reviewed and compared between LRP and RALP group. The data were analysed by SPSS software.
Results: The operative and post-operative parameters revealed significant decrease in the estimated blood loss (143 ml vs 306 ml, p < 0.001), the hospitalization days (6.9 days vs 8.7 days, p = 0.006) and the duration of Foley catheterization (9.3 days vs 11.3 days, p < 0.001) in patients underwent RALP. Positive surgical margin rate was reported in 39% in LRP and 49% in RALP (p = 0.285). The proportion of postoperative PSA ≤ 0.02 ng/ml in 6 months was reported in 73% in LRP and 68% in RALP (p = 0.573). The major postoperative complications (Clavien-Dindo Classification grade III) occurred in 5 patients underwent LRP (5%). The patients underwent RALP had no major postoperative complications.
Conclusions: Patients underwent RALP had better perioperative outcome, and had similar short-term oncologic outcome regarding PSA follow-up compared to LRP.