經腹腔及腹腔外達文西腹腔鏡攝護腺全切除手術的比較
林才揚1、黃冠華1、李高漢1、賴韋宏3
1奇美醫學中心 外科部 泌尿科 尿腫瘤科, 2戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Comparison of extraperitoneal versus transperitoneal robot-assisted laparoscopic radical prostatectomy: A single surgeon retrospective study
Chye-Yang Lim1, Steven Kuan-Hua Huang1, Kau Han Lee1, Wei-Hong Lai2
1Division of Urology, Department of Surgery, Division of Uro-Oncology, Chi Mei Medical Center, Tainan, Taiwan, 2Division of urology, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose:
Nowadays, robot-assisted laparoscopic radical prostatectomy (RALRP) has replaced the conventional laparoscopy. It provides the surgeon in a comfortable status including 3 dimension vision, elimination of natural tremor and dexterity of the instrument to accomplish an operation. However, transperitoneal RALRP would contact with the bowel. Therefore extraperitoneal approach is a good option to overcome this problem. The aim of our study is to compare the operative and oncological outcome of extraperitoneal and transperitoneal RALRP by a single surgeon in our center.
Materials and Methods:
We retrospectively enrolled the patients with prostate cancer who underwent RALRP by a single surgeon in Chi-Mei Medical Center from March 2014 to January 2017. Initially transperitoneal RALRP done then converted to extraperitoneal method since January 2016. Thus the recent 50 transperitoneal cases before conversion included. Meanwhile the first 10 extraperitoneal cases excluded to avoid the learning curve bias. Finally, comparison 100 patients who underwent transperitoneal or extraperitoneal in 1:1 ratio.
Results:
There was no significant difference for age, prostate volume, preoperative PSA, Gleason score on biopsy and final specimen, clinical and pathological stage and surgical margin. Transperitoneal RALRP had shorter trocar insertion time (11 versus 18.8 min), but extraperitoneal RALRP got shorter console time(113 versus 165.8 min). In addition, extraperitoneal RALRP showed the lesser amount of estimated blood loss(244ml vs 361ml). Meanwhile the catheterization duration and length of hospitalization were found shorter in extraperitoneal RALRP (4.8 vs 7.7 days, 7.2 vs 8.3 days). However the complication rate was higher in transperitoneal method.
Conclusion:
In our experience, extraperitoneal RALRP is quicker, safer and provides similar outcomes compared to transperitoneal RALRP. It could be considered as an alternative to transperitoneal RALRP especially for those with previous abdominal surgery.