Name: retzius-sparing robot-assisted radical prostatectomy
Uploaded: 2022-05-19T14:00:00
Description: Watch this Scientific Journal Video about Retzius-Sparing Robot-Assisted Radical Prostatectomy at JoVE.com

这项研究没有获得任何资金。

这项研究已提交给根特大学医院的地方伦理委员会，并已获得机构批准（EC UZG 2019/1506）。该研究已在比利时研究注册处注册，参考号为B670201941650。所有患者均提供了书面知情同意书。
1. 患者准备和定位
<ol><li>制备<ol><li>遵循当代国际公认的指南来诊断前列腺癌，并为根治性前列腺切除术1 设定适应症。使用多参数 MRI 进行局部分期，因为这提?...

<ol>
	<li>Mottet, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EAU-EANM-ESTRO-ESUR-SIOG+Guidelines+on+Prostate+Cancer-2020+Update.+Part+1:+Screening,+Diagnosis,+and+Local+Treatment+with+Curative+Intent.">EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent.</a> European Urology. 79 (2), 243-262 (2021).</li><li>Ilic, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+and+robotic-assisted+versus+open+radical+prostatectomy+for+the+treatment+of+localised+prostate+cancer.">Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer.</a> The Cochrane Database of Systematic Reviews. 9 (9), (2017).</li><li>Ab del Raheem, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retzius-sparing+robot-assisted+radical+prostatectomy+versus+open+retropubic+radical+prostatectomy:+a+prospective+comparative+study+with+19-month+follow-up.">Retzius-sparing robot-assisted radical prostatectomy versus open retropubic radical prostatectomy: a prospective comparative study with 19-month follow-up.</a> Minerva Urologica e Nefrologica: The Italian Journal of Urology and Nephrology. 72 (5), 586-594 (2020).</li><li>Gandaglia, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+effectiveness+of+robot-assisted+and+open+radical+prostatectomy+in+the+postdissemination+era.">Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era.</a> Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 32 (14), 1419-1426 (2014).</li><li>Ficarra, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+and+meta-analysis+of+studies+reporting+urinary+continence+recovery+after+robot-assisted+radical+prostatectomy.">Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy.</a> European Urology. 62 (3), 405-417 (2012).</li><li>Martini, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Contemporary+techniques+of+prostate+dissection+for+robot-assisted+prostatectomy.">Contemporary techniques of prostate dissection for robot-assisted prostatectomy.</a> European Urology. 78 (4), 583-591 (2020).</li><li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+anatomic+approach+for+robot-assisted+laparoscopic+prostatectomy:+a+feasibility+study+for+completely+intrafascial+surgery.">A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery.</a> European Urology. 58 (3), 457-461 (2010).</li><li>Checcucci, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retzius-sparing+robot-assisted+radical+prostatectomy+vs+the+standard+approach:+a+systematic+review+and+analysis+of+comparative+outcomes.">Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes.</a> BJU International. 125 (1), 8-16 (2020).</li><li>Montorsi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Best+practices+in+robot-assisted+radical+prostatectomy:+recommendations+of+the+Pasadena+Consensus+Panel.">Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel.</a> European Urology. 62 (3), 368-381 (2012).</li><li>Stabile, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multiparametric+MRI+for+prostate+cancer+diagnosis:+current+status+and+future+directions.">Multiparametric MRI for prostate cancer diagnosis: current status and future directions.</a> Nature Reviews. Urology. 17 (1), 41-61 (2020).</li><li>Dindo, D., Demartines, N., Clavien, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Classification+of+surgical+complications:+a+new+proposal+with+evaluation+in+a+cohort+of+6336+patients+and+results+of+a+survey.">Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.</a> Annals of Surgery. 240 (2), 205-213 (2004).</li><li>Xylinas, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+combined+oncological+and+functional+outcomes+after+radical+prostatectomy:+trifecta+rate+of+achieving+continence,+potency+and+cancer+control--a+literature+review.">Evaluation of combined oncological and functional outcomes after radical prostatectomy: trifecta rate of achieving continence, potency and cancer control--a literature review.</a> Urology. 76 (5), 1194-1198 (2010).</li><li>Walz, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+critical+analysis+of+the+current+knowledge+of+surgical+anatomy+related+to+optimization+of+cancer+control+and+preservation+of+continence+and+erection+in+candidates+for+radical+prostatectomy.">A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy.</a> European Urology. 57 (2), 179-192 (2010).</li><li>Walz, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+critical+analysis+of+the+current+knowledge+of+surgical+anatomy+of+the+prostate+related+to+optimisation+of+cancer+control+and+preservation+of+continence+and+erection+in+candidates+for+radical+prostatectomy:+An+update.">A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update.</a> European Urology. 70 (2), 301-311 (2016).</li><li>Albisinni, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+comparing+Anterior+vs+Retzius-sparing+robotic+assisted+radical+prostatectomy:+can+the+approach+really+make+a+difference.">Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference.</a> Minerva Urology and Nephrology. , (2021).</li><li>Menon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+recovery,+oncologic+outcomes+and+postoperative+complications+after+robot-assisted+radical+prostatectomy:+An+evidence-based+analysis+comparing+the+Retzius+sparing+and+standard+approaches.">Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: An evidence-based analysis comparing the Retzius sparing and standard approaches.</a> The Journal of Urology. 199 (5), 1210-1217 (2018).</li><li>Olivero, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retzius-sparing+robotic+radical+prostatectomy+for+surgeons+in+the+learning+curve:+A+propensity+score-matching+analysis.">Retzius-sparing robotic radical prostatectomy for surgeons in the learning curve: A propensity score-matching analysis.</a> European Urology Focus. 7 (4), 772-778 (2021).</li><li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retzius-sparing+robot-assisted+radical+prostatectomy:+early+learning+curve+experience+in+three+continents.">Retzius-sparing robot-assisted radical prostatectomy: early learning curve experience in three continents.</a> BJU International. 127 (4), 412-417 (2021).</li><li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Beyond+the+learning+curve+of+the+Retzius-sparing+approach+for+robot-assisted+laparoscopic+radical+prostatectomy:+oncologic+and+functional+results+of+the+first+200+patients+with+&gt;/=+1+year+of+follow-up.">Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with &gt;/= 1 year of follow-up.</a> European Urology. 64 (6), 974-980 (2013).</li><li>Hoffman, K. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-reported+outcomes+through+5+years+for+active+surveillance,+surgery,+brachytherapy,+or+external+beam+radiation+with+or+without+androgen+deprivation+therapy+for+localized+prostate+cancer.">Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.</a> JAMA. 323 (2), 149-163 (2020).</li><li>Dalela, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+pragmatic+randomized+controlled+trial+examining+the+impact+of+the+Retzius-sparing+approach+on+early+urinary+continence+recovery+after+robot-assisted+radical+prostatectomy.">A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy.</a> European Urology. 72 (5), 677-685 (2017).</li><li>Yossepowitch, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Positive+surgical+margins+after+radical+prostatectomy:+a+systematic+review+and+contemporary+update.">Positive surgical margins after radical prostatectomy: a systematic review and contemporary update.</a> European Urology. 65 (2), 303-313 (2014).</li><li>Vale, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adjuvant+or+early+salvage+radiotherapy+for+the+treatment+of+localised+and+locally+advanced+prostate+cancer:+a+prospectively+planned+systematic+review+and+meta-analysis+of+aggregate+data.">Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data.</a> Lancet. 396 (10260), 1422-1431 (2020).</li><li>Lumen, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safe+introduction+of+robot-assisted+radical+prostatectomy+after+a+training+program+in+a+high-volume+robotic+centre.">Safe introduction of robot-assisted radical prostatectomy after a training program in a high-volume robotic centre.</a> Urologia Internationalis. 91 (2), 145-152 (2013).</li><li>Galfano, A., Secco, S., Bocciardi, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mottrie+A.+Retzius-sparing+robot-assisted+laparoscopic+radical+prostatectomy:+An+international+survey+on+surgical+details+and+worldwide+diffusion.">Mottrie A. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: An international survey on surgical details and worldwide diffusion.</a> European Urology Focus. 6 (5), 1021-1023 (2020).</li><li>Checcucci, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Precision+prostate+cancer+surgery:+an+overview+of+new+technologies+and+techniques.">Precision prostate cancer surgery: an overview of new technologies and techniques.</a> Minerva Urologica e Nefrologica: The Italian Journal of Urology and Nephrology. 71 (5), 487-501 (2019).</li><li>Grasso, A. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Posterior+musculofascial+reconstruction+after+radical+prostatectomy:+an+updated+systematic+review+and+a+meta-analysis.">Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.</a> BJU International. 118 (1), 20-34 (2016).</li><li>Manfredi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+anatomical+reconstruction+during+robot-assisted+radical+prostatectomy:+focus+on+urinary+continence+recovery+and+related+complications+after+1000+procedures.">Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.</a> BJU international. 124 (3), 477-486 (2019).</li></ol>

在RS-RRP期间，整个过程是通过后端接近膀胱来执行的。因此，与SA-RARP的主要区别在于保留了Retzius的空间。保留Retzius的空间有几个解剖学优势7：首先，膀胱没有与腹壁分离，脐带没有横断。因此，膀胱保持在其解剖位置。其次，逼尿肌前围裙和耻骨前列腺韧带未横断。虽然称为耻骨前列腺韧带，但这些韧带延伸到膀胱前表面，最好称为耻骨韧带13。这些韧带是?...

为了治愈局部和选定的局部晚期前列腺癌病例，根治性前列腺切除术是推荐的治疗方案之一1。与开放性根治性前列腺切除术2，3 相比，微创技术（常规腹腔镜检查和机器人辅助腹腔镜检查）具有降低失血、术后疼痛和住院时间的优势。在微创技术中，机器人辅助手术结合了微创手术的优点，增加了手术器械的灵活性和移动自由度，并具有三维围手术期视觉。在资源丰富的国家，机器人辅助根治性前列腺切除术（RARP）已成为进行根治性前列腺切除术的主要模式4。
暂时性或确定性尿失禁是根治性前列腺切除术的常见副作用，无论其实施方式如何5.对于开放性（腹部）、腹腔镜和“标准”前 RARP （SA-RARP），根治性前列腺切除术采用前路入路进行，其中耻骨后 （Retzius） 空间被打开6.由于与 RARP 相关的灵活性增加，另一种解剖学方法是可能的，其中前列腺通过直肠袋或道格拉斯袋切除，如 Galfano 等人首次描述的那样7。这种后方方法使雷齐乌斯的空间完好无损（“雷齐乌斯保留的RARP”;RS-RARP）。RS-RARP 的主要优点似乎是尿失禁恢复更快、更快8.本研究旨在详细描述（如帕萨迪纳共识小组9所建议的那样）由视听材料支持的RS-RRP步骤，并报告单个中心中第一批病例的早期功能和肿瘤学结果。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>adhesive tape</td>
			<td>BSNmedical</td>
			<td>15200028</td>
			<td>Tensoplast</td>
		</tr>
		<tr>
			<td>assistant trocar 5mm</td>
			<td>Aesculap</td>
			<td>EKO17R</td>
			<td>reusable trocar</td>
		</tr>
		<tr>
			<td>assistant trocar 12mm</td>
			<td>Conmed</td>
			<td>iAS12-120LPi</td>
			<td>AirSeal trocar</td>
		</tr>
		<tr>
			<td>barbed wire</td>
			<td>Covidien</td>
			<td>VLOCM0024</td>
			<td>for vesico-urethral anastomosis</td>
		</tr>
		<tr>
			<td>Cadiere forceps</td>
			<td>Intuitive</td>
			<td>470049</td>
			<td>robotic instrument, grasper</td>
		</tr>
		<tr>
			<td>camera 30&#176;</td>
			<td>Intuitive</td>
			<td>470027</td>
			<td>endoscope</td>
		</tr>
		<tr>
			<td>cefazolin</td>
			<td>Sandoz</td>
			<td>BE217296</td>
			<td>Belgian farmaceutical registration</td>
		</tr>
		<tr>
			<td>CO2-insufflator</td>
			<td>Conmed</td>
			<td>AS-iFS2</td>
			<td>AirSeal insufflator</td>
		</tr>
		<tr>
			<td>Da Vinci Xi system</td>
			<td>Intuitive</td>
			<td>600062</td>
			<td>robotic system</td>
		</tr>
		<tr>
			<td>endobag</td>
			<td>Covidien</td>
			<td>173050G</td>
			<td>Endo Catch 10mm</td>
		</tr>
		<tr>
			<td>endoscopic hem-o-lok applier</td>
			<td>Teleflex</td>
			<td>544995T</td>
			<td>to apply the locking clips</td>
		</tr>
		<tr>
			<td>fenestrated bipolar forceps</td>
			<td>Intuitive</td>
			<td>470205</td>
			<td>robotic instrument, bipolar forceps</td>
		</tr>
		<tr>
			<td>Hasson cone 8mm trocar</td>
			<td>Intuitive</td>
			<td>470398</td>
			<td>only at the camera trocar</td>
		</tr>
		<tr>
			<td>heparin, low molecular weight (enoxaparin)</td>
			<td>Sanofi</td>
			<td>BE144347</td>
			<td>Belgian farmaceutical registration</td>
		</tr>
		<tr>
			<td>hydrogel coated latex transurethral catheter</td>
			<td>Bard</td>
			<td>D226416</td>
			<td>Biocath</td>
		</tr>
		<tr>
			<td>insufflation cable</td>
			<td>Conmed</td>
			<td>ASM-EVAC1</td>
			<td>AirSeal Tri-lumen filtered tube set</td>
		</tr>
		<tr>
			<td>laparoscopic grasper</td>
			<td>Aesculap</td>
			<td>PO235R</td>
			<td>Atraumatic wave grasper, double action</td>
		</tr>
		<tr>
			<td>large needle driver</td>
			<td>Intuitive</td>
			<td>470006</td>
			<td>roboic instrument, needle driver</td>
		</tr>
		<tr>
			<td>locking clip</td>
			<td>Grena</td>
			<td>5-13mm</td>
			<td>Click&#39;aVplus</td>
		</tr>
		<tr>
			<td>metallic clips 5mm</td>
			<td>Aesculap</td>
			<td>PL453SU</td>
			<td>for vessel ligation</td>
		</tr>
		<tr>
			<td>monopolar curved scissor</td>
			<td>Intuitive</td>
			<td>470179</td>
			<td>robotic instrument, hot shears</td>
		</tr>
		<tr>
			<td>mosquito clamp</td>
			<td>Innovia Medical</td>
			<td>MQC2025-D</td>
			<td>to secure bladder suspension stitch</td>
		</tr>
		<tr>
			<td>natriumlaurylsulfoacetate-sorbitol-natriumcitratedihydrate clysma</td>
			<td>Johnson &#38; Johnson Consumer BV</td>
			<td>RVG 05069</td>
			<td>Belgian farmaceutical registration</td>
		</tr>
		<tr>
			<td>polyglactin 3.0 suture</td>
			<td>Ethicon</td>
			<td>V442H</td>
			<td>stay suture bladder neck, subcutaneous sutures</td>
		</tr>
		<tr>
			<td>polyglactin 1 suture</td>
			<td>Ethicon</td>
			<td>D9708</td>
			<td>stay suture fascia and fascia closurie</td>
		</tr>
		<tr>
			<td>povidone-iodine alcoholic solution</td>
			<td>Mylan</td>
			<td>BE230736</td>
			<td>Belgian farmaceutical registration</td>
		</tr>
		<tr>
			<td>robotic trocar 8mm</td>
			<td>Intuitive</td>
			<td>470002</td>
			<td>standard length</td>
		</tr>
		<tr>
			<td>Skin stapler</td>
			<td>Covidien</td>
			<td>8886803712</td>
			<td>skin closure</td>
		</tr>
		<tr>
			<td>sterile drapes robotic arms</td>
			<td>Intuitive</td>
			<td>470015</td>
			<td>draping system robotic arms</td>
		</tr>
		<tr>
			<td>suction-irrigation device</td>
			<td>Geyi</td>
			<td>GYSL-5X330</td>
			<td>laparoscopic use by assitant</td>
		</tr>
		<tr>
			<td>suspension sutures</td>
			<td>Ethicon</td>
			<td>628H</td>
			<td>Ethilon 2-0 nylon suture</td>
		</tr>
		<tr>
			<td>thrombo-embolus deterrent stockings</td>
			<td>Covidien</td>
			<td>7203</td>
			<td>T.E.D. stockings</td>
		</tr>
		<tr>
			<td>warming blanket device</td>
			<td>3M</td>
			<td>54200</td>
			<td>Bear Hugger</td>
		</tr>
	</tbody>
</table>

retzius-sparing robot-assisted radical prostatectomy

提供了保留Retzius的机器人辅助根治性前列腺切除术（RS-RARP）的技术以及在单个中心的初步经验。该技术将逐步描述，并通过视频进一步说明以增强可重复性。评估早期肿瘤学和功能结果。总共纳入77名患者，中位随访时间为11个月（范围：3-21个月）。51%的患者患有局部高风险或局部晚期前列腺癌。没有术中并发症，所有高级别并发症（2.6%）与RS-RRP同时进行的盆腔淋巴结清扫术有关。中位手术时间为160分钟（范围：122-265分钟），中位住院时间为3天（范围：3-8）。据报道，42.9% 的患者手术切缘阳性。一年生化无复发生存率为90.1%。6个月后，所有患者均处于社交状态，1年后，94.3%的患者完全进入社交状态。在至少接受单侧神经保留的性活跃患者中，43.3%能够进行。该系列强调了通过标准化技术进行RS-RRP的手术安全性，并证实了对尿失禁早期恢复的有益作用。需要告知患者手术切缘阳性的风险。

所有预期寿命>10年且无麻醉禁忌症的局部或局部晚期前列腺癌患者均提供RS-RARP作为其疾病的治疗选择之一。在临床试验或挽救性根治性前列腺切除术的背景下，接受转移性前列腺癌减瘤性根治性前列腺切除术的患者未提供RS-RARP，并且优选为前部肿瘤患者提供SA-RARP。随访少于3个月的患者被排除在外。手术前，所有患者均进行了血清前列腺特异性抗原（PSA）的测量并进行了MRI检查。术前通过经直肠...

Watch this Scientific Journal Video about Retzius-Sparing Robot-Assisted Radical Prostatectomy at JoVE.com

Retzius-Sparing Robot-Assisted Radical Prostatectomy

机器人辅助的Retzius保留根治性前列腺切除术是一种能够保持尿失禁或促进大多数患者尿失禁恢复的技术。必须告知患者手术切缘阳性的风险。

保留 retzius 机器人辅助根治性前列腺切除术

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The ...

Retzius保留机器人辅助方法改善了接受根治性前列腺切除术的前列腺癌患者的功能结果。Retzius-spare 机器人辅助方法改善了根治性前列腺切除术后尿失禁的早期恢复。首先，将患者置于仰卧位，固定手臂和腿部。然后，为了能够插入穿刺器，在脐上方约 1 厘米处纵向切开 2 至 2.5 厘米的皮肤切口。在腹膜腔上插入一个带有哈森锥体的八毫米机器人相机穿刺器，并将锥体的夹子连接到筋膜处的拉杆缝合线上。将患者置于 30 至 35 度的特伦德伦堡体位，以将小骨盆从小肠中解放出来。然后，水平到相机穿刺器，将两个用于机器人仪器的八毫米穿刺器放在相机穿刺器的左侧，一个在右侧放置，在穿刺器之间保持六到八厘米的距离。将患者推车移动到患者的右侧，直到第三个臂连接到相机穿刺器。连接其他三个八毫米穿刺器，手臂之间至少保持 10 厘米的距离，以避免在操作过程中发生碰撞。要进入精囊，请在两侧输精管上方切开腹膜，并继续内侧，直到这些切口相互到达。在切口的侧边缘，以圆周方式解剖输精管并横断。然后，解剖输精管内侧，直到到达精囊的尖端。如果没有精囊侵犯的证据，从巨大的囊泡内侧剥下Denonvilliers的筋膜。解剖后，通过双相止血将血管固定在精囊的尖端和侧表面，并对其进行横断。对于前列腺的侧向解剖，右侧使用Cadiere钳子，左侧使用辅助腹腔镜抓手，向内侧缩回精囊泡。为了便于进入前列腺和膀胱颈，将一根带有不可吸收缝合线的直针穿过腹膜切口的上部，在耻骨上方两到三厘米处，就在内侧脐带韧带的内侧。用直针穿孔腹膜切口的上部和下面的脂肪组织。为了使用双侧神经保留方法处理勃起神经，通过在前列腺筋膜和Denonvilliers筋膜之间进行钝性解剖来创建一个平面，直到前列腺顶点和横向直至遇到前列腺血管。对于非神经保留方法，如本例所示，在前列腺底部下方一到两毫升处切开Denonvilliers筋膜。然后，解剖直肠的前表面，并在直肠周围脂肪组织中更横向解剖。对于单侧保留神经的方法，首先在保留神经的一侧进行双侧神经保留法，在非保留神经的一侧进行非神经保留方法。然后，在直肠壁上方的中线切开Denonvilliers筋膜。接下来，将前列腺蒂拉紧，并用单极剪刀制作一个窗口。使用大型聚合物锁定夹固定椎弓根的一部分，该夹子穿过 12 毫米辅助穿刺器。然后，在夹子的前列腺侧横断面。通过钝性解剖从前列腺筋膜上剥离神经血管束，并使用Cadiere镊子进行渐进的内侧和向上回缩使束处于轻微张力下。对于膀胱颈的解剖，用Cadiere镊子抓住精囊并向下缩回，以在膀胱颈和前列腺底部之间产生张力。然后，在膀胱颈后侧做一个一厘米的粘膜切口，以检查尿道导管。将可吸收的聚乳糖 3/0 缝合线放在膀胱颈的后侧。然后，用开窗的双极钳抓住撑缝线，向上移动，直到膀胱颈的前部变得可见。进一步切开粘膜，从前列腺底部释放膀胱颈。然后，在膀胱颈完全松开之前，在膀胱颈的前侧放置第二次停留缝合线。对于前部夹层，使用钝性夹层和单极切口的组合来追踪前列腺前表面，保留圣托里尼神经丛、耻骨前列腺韧带和 Retzius 间隙。对于前列腺顶点夹层，在尿道的圆形纤维上切开一到两毫米的切口，尾部朝向前列腺顶端。然后，将圆形纤维推向前列腺的顶点，以暴露尿道的内纵层。使内层尽可能靠近前列腺进行横断面，以保留括约肌。通过 12 毫米辅助穿刺器插入内窥袋，放入前列腺和精囊。识别膀胱颈和膀胱粘膜。拉动前留缝线。然后，将第一条可吸收带刺铁丝网的第一条缝合线外向内，就在膀胱颈上 12 点钟位置右侧的侧面。通过将尿道导管的尖端移动到膜性尿道中来识别尿道，然后将缝合线从内向外放置在尿道上，并在 12 点钟位置的右侧稍微侧向。然后，将第二条可吸收带刺铁丝网的第一缝合线外向内，外侧放置在膀胱颈上 12 点钟位置的左侧，并在尿道上由内向外放置在同一位置。用第二根带刺铁丝网在膀胱颈外向内重复缝合，在尿道上由内向外缝合两次，直到到达九点钟位置。在右侧进行缝合，第一根带刺铁丝网外向内在膀胱颈上，从内向外缝合尿道，直到到达六点钟位置。然后，继续左侧的吻合，从九点钟位置到六点钟位置。完成后，抓住导管的尖端以放置在膀胱中并向球囊充气。然后，收紧左右两侧的最后缝合线，直到膀胱和尿道粘膜近似。通过在膀胱中滴注120毫升水来检查吻合口的水密性。使用带刺铁丝网的残骸，将两侧从内侧到外侧的腹膜切口闭合。要提取前列腺，切开脐上皮肤和筋膜切口。然后，用皮肤吻合器关闭所有皮肤切口。在这项研究中，77名患者接受了保留Retzius的机器人辅助桡骨前列腺切除术的治疗。患者中位年龄为65岁，血清前列腺特异性抗原为7.7纳克/毫升。患者的术前肿瘤特征总结见表。中位手术时间为160分钟，中位住院时间为3天。9例患者因导尿管停留时间过长而出现一级并发症。两名患者患有高级别并发症，包括淋巴囊收缩，需要经皮引流。一名患者接受了抗生素治疗感染的淋巴囊肿。37例患者在最终病理检查时有额外的胶囊或延长，或精囊浸润。其他40例患者被归类为PT2疾病。此外，33例患者报告了阳性手术切缘。随访11个月后，7名患者生化复发。术后大陆状态，三个月后，71例患者处于社会状态。六个月后，所有可评估的患者都接受了社交活动。3个月后，43例患者实现了完全失禁。完全尿失禁逐渐增加，12个月后，94.3%的可评估患者完全尿失禁。此处显示了至少随访一年的性活跃患者的效力状态的详细信息。在前夹层期间，保留圣托里尼神经丛、耻骨前列腺韧带和 Retzius 间隙对于改善该方法的功能结局至关重要。该过程也可以通过经典的机器人前路甚至开放式入路来执行。问题仍然存在，这些方法是否产生相同的肿瘤学和功能结果。

Research

JoVE Journal

Medicine

Generating a Murine Orthotopic Metastatic Breast Cancer Model and Performing Murine Radical Mastectomy

小鼠原位转移性乳腺癌模型的建立及小鼠根治性乳房切除术

In vivo mouse models to assess breast cancer progression are essential for cancer research, including preclinical drug developments. However, the majority ...

科研

医学

Isolation of Adipose Derived Regenerative Cells for the Treatment of Erectile Dysfunction Following Radical Prostatectomy

分离脂肪衍生的再生细胞用于治疗根治性前列腺切除术后的勃起功能障碍

Stem cells are used in many research areas within regenerative medicine in part because these treatments can be curative rather than symptomatic. Stem ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

机器人辅助胰腺切除术的技术细节

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

胰腺癌的腹腔镜根左造影切除术：手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

机器人辅助基质前体模块化胰腺切除术，包括切除和重建的斯普尔诺-梅森特克结

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the ...

Robotic Radical Cystectomy, Pelvic Lymph Node Dissection, and Intracorporeal Ileal Conduit Urinary Diversion

The robotic approach to radical cystectomy is compelling because of its oncologic equivalence to open radical cystectomy (ORC), its association with lower ...

Robot-Assisted Kidney Transplantation

机器人辅助肾移植

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

机器人辅助全直肠系膜切除术和盆腔外侧淋巴结清扫术治疗局部晚期中低直肠癌

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

骨科机器人辅助股骨颈系统治疗股骨颈骨折

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...