目的:本病例系列描述了澳大利亚多名外科医生进行机器人辅助膀胱憩室切除术(RABD)的经验和结果,突出程序有效性和安全性,憩室切除术的良性和恶性适应症。
方法:分析了2016年至2023年期间进行RABD的13位经验丰富的澳大利亚泌尿科医师的结果。对前瞻性收集的数据进行回顾性分析,包括患者人口统计学,憩室特征,手术方法,和术后结果。手术技术包括膀胱外和膀胱内入路,重点是在恶性肿瘤病例中保持肿瘤原则。
结果:共有28例患者接受了RABD,大多数是男性,平均年龄为63.9岁。所有外科医生都采用了四口经腹膜入路,并选择了憩室颈的外解剖,1例同时使用外和跨憩室入路。非恶性憩室患者的功能结果表现出症状缓解,而肿瘤学结果显示90%的恶性病例有明显的切缘。手术的平均时间是106分钟,失血最少,平均住院时间为2.67天。早期并发症发生率为14%,大多数为Clavien-DindoII级。
结论:机器人膀胱憩室切除术,主要通过腹膜外入路,已经成为保险箱,有效,以及对恶性和非恶性膀胱憩室的可靠手术干预。一致的手术方法和优秀的结果证明在这个案例系列加强手术的潜力作为一个安全的选择,即使是憩室内的恶性肿瘤。
Purpose: This
case series describes the experiences and outcomes of multiple Australian surgeons performing robotic-assisted bladder diverticulectomy (RABD), highlighting the procedural effectiveness and safety, for both benign and malignant indications for diverticulectomy. Methods: Outcomes were analyzed from 13 experienced Australian urologists who performed RABD between 2016 and 2023. Retrospective analysis was performed on prospectively collected data, which included patient demographics, diverticulum characteristics, surgical approaches, and post-operative outcomes. Surgical techniques included the extravesical and intravesical approaches, with the focus on maintaining oncological principles in cases of malignancy. Results: A total of 28 patients underwent RABD, with the majority being male and a mean age of 63.9 years. All surgeons utilized a four-port transperitoneal approach and opted for the extravesical dissection of the diverticular neck; one
case utilized both an extravesical and a trans-diverticular approach. Functional outcomes demonstrated symptomatic resolution in patients with nonmalignant diverticula, whereas oncological outcomes indicated clear margins in 90% of malignant cases. The average length of the procedure was 106 minutes, with minimal blood loss and a mean hospital stay of 2.67 days. Early complications occurred in 14% with the majority Clavien-Dindo grade II. Conclusion: Robotic bladder diverticulectomy, predominantly via the transperitoneal extravesical approach, has emerged as a safe, effective, and reliable surgical intervention for both malignant and nonmalignant bladder diverticula. The consistent surgical approach and excellent outcomes demonstrated in this
case series reinforce the procedure\'s potential as a safe option, even in the setting of malignancy within a diverticulum.