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首页> 外文期刊>BMC Urology >New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients
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New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients

机译：腹膜外方法机器人辅助根治性前列腺切除术的新步骤：日本患者腹膜外和经腹膜方法的倾向得分匹配比较

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Robot-assisted radical prostatectomy (RARP) is commonly performed using the transperitoneal (TP) approach with six trocars over an 8-cm distance in the steep Trendelenburg position. In this study, we investigated the feasibility and the benefit of using the extraperitoneal (EP) approach with six trocars over a 4-cm distance in a flat or 5° Trendelenburg position. We also introduced four new steps to the surgical procedure and compared the surgical results and complications between the EP and TP approach using propensity score matching. Between August 2012 and August 2016, 200 consecutive patients without any physical restrictions underwent RARP with the EP approach in a less than 5° Trendelenburg position, and 428 consecutive patients underwent RARP with the TP approach in a steep Trendelenburg position. Four new steps to RARP using the EP approach were developed: 1) arranging six trocars; 2) creating the EP space using laparoscopic forceps; 3) holding the separated prostate in the EP space outside the robotic view; and 4) preventing a postoperative inguinal hernia. Clinicopathological results and complications were compared between the EP and TP approaches using propensity score matching. Propensity scores were calculated for each patient using multivariate logistic regression based on the preoperative covariates. All 200 patients safely underwent RARP using the EP approach. The mean volume of estimated blood loss and duration of indwelling urethral catheter use were significantly lower with the EP approach than the TP approach (139.9 vs 184.9?mL, p?=?0.03 and 5.6 vs 7.7?days, p?
机译：机器人辅助根治性前列腺切除术（RARP）通常是通过腹膜（TP）方法在陡峭的特伦德伦伯卧位上用六根套管针在8厘米的距离上进行的。在这项研究中，我们调查了在平面或5°特伦德伦伯卧位中，在4厘米距离上使用六根套管针进行腹膜外（EP）方法的可行性和益处。我们还介绍了外科手术的四个新步骤，并使用倾向评分匹配比较了EP和TP方法的手术结果和并发症。在2012年8月至2016年8月之间，连续200名无任何身体限制的患者在特伦德伦伯卧位小于5度的位置接受了EP方法的RARP，并且有428名连续患者在特伦德伦伯卧位的陡峭位置接受了TP方法的RARP。开发了使用EP方法的RARP的四个新步骤：1）安排六只套管针; 2）使用腹腔镜钳创造EP空间; 3）将分离的前列腺保持在机器人视野之外的EP空间中; 4）预防术后腹股沟疝。使用倾向评分匹配法比较了EP和TP方法的临床病理结果和并发症。基于术前协变量，使用多元逻辑回归计算每个患者的倾向得分。所有200例患者均采用EP方法安全地接受了RARP。 EP方法的平均估计失血量和留置尿道导管的时间显着低于TP方法（139.9 vs. 184.9？mL，p？=？0.03和5.6 vs. 7.7？天，p？<？0.01，分别）。阳性切缘未观察到明显差异。在我们引入这项技术后，没有患者在手术后出现腹股沟疝。无论患者的体质或陡峭的特伦德伦伯卧位禁忌症，都可以安全地执行RARP的EP方法。我们的方法涉及使用EP方法执行RARP，可以减少围手术期失血量，留置尿道导管的使用时间以及术后腹股沟疝的发生率。

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