Retzius空間保留之攝護腺根除手術：由機械手臂到傳統腹腔鏡的逆向推演
胡如娟、裘坤元
臺中榮民總醫院泌尿外科
Retzius-sparing laparoscopic radical prostatectomy: A reversed evolution from robotic-assisted radical prostatectomy
Ju-Chuan Hu, Kun-Yuan Chiu
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: The developement of Robotic-assisted Retzius-sparing radical prostatectomy (RS-RaRP) is based on the idea of avoiding the destruction of the anatomic structures around the prostate (ie, Santorini plexus, puboprostatic ligaments, endopelvic fascia, veil of Aphrodite) by passing through a Douglas incision. The theoretical benefits of anatomic preservation might achieve better functional outcomes (continence and potency). We modified the technique of Retzius-sparing radical prostatectomy with a reversed evolution from robotic-assisted to laparoscopic methodology.
Materials and Methods: From May 2015 to March 2017, fifteen patients underwent Retzius-sparing laparoscopic radical prostatectomy (RS-LRP). The general characters of patients, peri-operative parameters, functional and oncologic datas were collectedprospectively. The surgical techniques including trocar positions and detailed operative steps had been described in our prior video: Videourology. January 2017, 31. doi: 10.1089/vid.2016.0044. Cystography was performed on post-operative day 3 and the Foley catheter would be removed on post-operative day 4 if no leakage on cystography. Continence was defined as no need for pad in daily life (including protective pad).
Results: The average operative time was 212 minutes while the average period of anastomosis was 46 minutes. The average amount of blood loss was 186 ml. Three patients received bilateral neurovascular bundles(NVB) preserving and six patients received unilateral NVB preserving. The other six patients received prostatectomy without NVB preserving. The median Foley catheter indwelling period was four days. Ten patients got immediate continence at the first day of Foley catheter removal. The other five patients had mild post-operative anastomotic leakage and initial mild stress urine incontinence but all of them got recovery to no need for pad within 2 months.
Conclusion: At the very first time we showed the RS-LRP is a feasible option for localized prostate cancer. It might result in early continence control in our initial experience and with less financial cost for patients. Further long-term prospective studies are needed to define the benefits of this technical method on trifecta.