一個創新的手術方式: 機械手臂輔助逆向式簡單攝護腺切除

翁瑋駿、童敏哲、許兆畬、黃立華、楊晨洸¹、歐宴泉¹

童綜合醫院 外科部 泌尿科；¹台中榮民總醫院 外科部 泌尿科

A novel method to do robot-assisted simple prostatectomy from retrograde approach

Wei-Chun Weng, Min-Che Tung, Jow-Yu Sheu, Li-Hua Huang, Chun-Kuang Yang¹, Yen-Chuan Ou¹

Divisions of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taiwan

¹Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan

Purpose: To evaluate the feasibility and reproducibility of robot-assisted retrograde approach for simple prostatectomy.

Materials and Methods: From April 2016 to March 2017, 15 patients received robot-assisted retrograde simple prostatectomy (RARSP) for high-volume symptomatic prostate hyperplasia. Four of them had been indwelled with Foley catheter preoperatively. The average prostate volume was 71ml. The mean max flow rate was 6.9ml/sec. Other than suprapubic approach to perform simple prostatectomy, these patients underwent retropubic approach method. The difference was that we started the procedure by transecting the urethra and made retrograde dissection from prostate apex to prostato-vesical junction. The procedure preserved underlying prostate capsule and therefore did minimum damage to neurovascular bundle. We anastomosed the bladder neck and urethra stump.

Results: The median operative duration was 115 min and mean blood loss is 64ml. No patient needed continuous catheter irrigation and the mean catheter duration was 7.4 days. The mean postoperative peak urinary flow was 19.2 mL/s, while the mean IPSS had 3.4 points improvement. Fourteen patients (93.3%) reached dry continence in 2 weeks postoperatively.

Conclusions: RARSP has outcome advantages when compared with the open or with other minimally invasive techniques (laser enucleation or bipolar TURP). Our retrograde method makes the procedure easier and the anastomosis between the bladder neck and urethra results in a quicker postoperative recovery. As a result, a RARSP approach combining with anastomosis is worth considering in cases of symptomatic high-volume prostate.