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首页> 外文期刊>BJU international >Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion.
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Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion.

机译：保留神经的机器人辅助根治性膀胱前列腺切除术和尿流改道。

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OBJECTIVE: To develop a technique of nerve-sparing robot-assisted radical cystoprostatectomy (RRCP) for patients with bladder cancer. PATIENTS AND METHODS: Robotic assistance should enhance the ability to preserve the neurovascular bundles during laparoscopic radical cystectomy. Thus we undertook RRCP and urinary diversion using a three-step technique. First, using a six-port approach and the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), one surgeon carried out a complete pelvic lymphadenectomy and cystoprostatectomy using a technique developed specifically for robotic surgery. The neurovascular bundles were easily identified and dissected away, the specimen entrapped in a bag and removed through a 5-6 cm suprapubic incision. Second, a different surgical team exteriorized the bowel through this incision and created a neobladder extracorporeally. Third, the neobladder was internalized, the incision closed and the primary surgeon completed the urethro-neovesical anastomosis with robotic assistance. RESULTS: RRCP was carried out in 14 men and three women by the primary surgeon (M.M.). The form of urinary reconstruction was ileal conduit in three, a W-pouch with a serosal-lined tunnel in 10, a double-chimney or a T-pouch with a serosal-lined tunnel in two each. The mean operative duration for robotic radical cystectomy, ileal conduit and orthotopic neobladder were 140, 120 and 168 min, respectively. The mean blood loss was < 150 mL. The number of lymph nodes removed was 4-27, with one patient having N1 disease. The margins of resection were free of tumour in all patients. CONCLUSIONS: We developed a technique for nerve-sparing RRCP using the da Vinci system which allows precise and rapid removal of the bladder with minimal blood loss. The bowel segment can be exteriorized and the most complex form of orthotopic bladder can be created through the incision used to deliver the cystectomy specimen. Performing this part of the operation extracorporeally reduced the operative duration.
机译：目的：为膀胱癌患者开发一种节省神经的机器人辅助根治性膀胱前列腺切除术（RRCP）技术。患者和方法：机器人辅助应提高腹腔镜根治性膀胱切除术中保存神经血管束的能力。因此，我们使用三步技术进行了RRCP和尿液转移。首先，使用六端口方法和达芬奇手术系统（美国加利福尼亚州桑尼维尔的直觉外科医院），一名外科医生使用专门为机器人手术开发的技术进行了完整的盆腔淋巴结清扫术和膀胱前列腺切除术。神经血管束很容易识别并解剖，将标本包裹在袋子中，并通过耻骨上5-6 cm切口取出。其次，另一个外科团队通过该切口使肠外露，并在体外形成了新膀胱。第三，将新膀胱内化，闭合切口，并由外科医生在机器人协助下完成尿道-神经血管吻合术。结果：RRCP由主要外科医生（M.M.）进行了14例男性和3例女性。尿路重建的形式是：回肠导管分为三个，一个是W-袋，一个带浆膜衬里的隧道在十个，一个双烟囱或一个T-袋，一个带浆膜衬里的隧道，每个在两个。机器人根治性膀胱切除术，回肠导管和原位新膀胱的平均手术时间分别为140、120和168分钟。平均失血量<150 mL。淋巴结清除数量为4-27，其中一名患者患有N1疾病。所有患者的切除切缘均无肿瘤。结论：我们开发了一种使用达芬奇系统的神经保护性RRCP技术，该技术能够以最小的失血量快速准确地去除膀胱。肠段可以外化，并且可以通过用于递送膀胱切除术标本的切口创建最复杂的原位膀胱形式。进行这部分手术可以减少手术时间。

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