■随着达芬奇单端口(SP)机器人平台的引入,在狭窄的空间中手术变得更加容易,用这个,最近经常进行腹膜外前列腺癌根治术。然而,与现有方法进行比较的研究仍然缺乏。因此,在这项研究中,我们比较了初次腹膜外单孔机器人辅助前列腺癌根治术(spRARP)和腹膜内多孔机器人辅助前列腺癌根治术(mpRARP),并试图探讨腹膜外spRARP的可行性.
■我们回顾性分析了在2019年1月至2023年4月期间接受RARP的患者。本研究共纳入184例连续患者:64例接受spRARP,120例接受mpRARP。手术前后的患者特征进行了调查,和通过气体的时间,Foley保养期,住院时间,并对疼痛变化进行比较分析,以估计术后恢复情况.为了解决源自基线时不同患者特征的固有偏差,我们在倾向得分匹配(PSM)(比率,1:1).
■PSM后,spRARP组和mpRARP组各有64例患者.在术前检查中,前列腺特异性抗原水平没有显着差异,格里森评分(GS),前列腺体积,磁共振成像T分期,或前列腺影像报告和数据系统评分。手术后,两组在手术时间和控制台时间上无显著差异.值得注意的是,spRARP组的估计失血量明显低于mpRARP组(P=0.049).当比较病理结果时,GS,T级,切缘阳性,囊外延伸,精囊浸润率两组间差异无统计学意义。四名接受spRARP的患者和六名接受mpRARP的患者遭受Clavien-Dindo分类3级和4级并发症。三个月后,两组在失禁或效能方面无显著差异.然而,即使在PSM之后,spRARP组的气体通过周期比mpRARP组早。
■在这项研究中,腹膜外spRARP组和经腹膜mpRARP组的并发症发生率和手术结局相似.此外,spRARP组手术时间短,恢复早.因此,腹膜外spRARP是一种可行的方法,有望在未来变得越来越流行。
UNASSIGNED: With the introduction of the da Vinci single-port (SP) robot platform, surgery in a narrow space has become easier, and using this, extraperitoneal radical prostatectomy has been frequently performed recently. However, studies comparing it with existing methods are still lacking. Therefore, in this study, we compared the initial extraperitoneal single-port robot-assisted radical prostatectomy (spRARP) with intraperitoneal multiport robot-assisted radical prostatectomy (mpRARP) and tried to investigate the feasibility of extraperitoneal spRARP.
UNASSIGNED: We retrospectively analyzed patients who underwent RARP performed between January 2019 and April 2023. A total of 184 consecutive patients were enrolled in this study: 64 underwent spRARP and 120 underwent mpRARP. Patient characteristics before and after surgery were investigated, and period of passing gas, foley maintenance period, length of hospital stay, and pain changes were compared and analyzed to estimate post-surgery recovery. To address inherent biases stemming from differing patient characteristics at baseline, we performed an additional analysis after propensity score matching (PSM) (ratio, 1:1).
UNASSIGNED: After PSM, both the spRARP and mpRARP groups consisted of 64 patients each. On preoperative examination, there were no significant differences in prostate-specific antigen level, Gleason score (GS), prostate volume, magnetic resonance imaging T stage, or Prostate Imaging-Reporting and Data System score between the two groups. Following surgery, there were no significant differences in operative and console time between the two groups. Notably, the estimated blood loss was considerably lesser in the spRARP group than in the mpRARP group (P=0.049). When comparing pathologic outcomes, the GS, T stage, positive surgical margin, extracapsular extension, and seminal vesicle invasion rates showed no significant differences between the two groups. Four patients who underwent spRARP and six who underwent mpRARP suffered Clavien-Dindo classification grade 3 and 4 complications. After 3 months, there were no significant differences in incontinence or potency between the two groups. However, even after PSM, the period of passing gas was earlier in the spRARP group than in the mpRARP group.
UNASSIGNED: In this study, both the extraperitoneal spRARP and transperitoneal mpRARP groups exhibited similar complication rates and surgical outcomes. Furthermore, the spRARP group had a short surgical time and demonstrated early recovery. Therefore, extraperitoneal spRARP is a feasible procedure that is expected to become increasingly popular in the future.