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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 293 -297. doi: 10.3877/cma.j.issn.1674-3253.2022.04.002

临床研究

国产单孔蛇形臂机器人手术系统在前列腺癌根治术中的初步应用
张超1, 魏勇2, 景泰乐3, 王正1, 肖成武1, 沈露明2, 杨健2, 彭鼎3, 杨波1, 汪朔3, 夏丹3,†(), 朱清毅2,†(), 王林辉1,†()   
  1. 1. 200433　上海，海军军医大学第一附属医院泌尿外科
    2. 210011　南京医科大学第二附属医院泌尿外科
    3. 310009　杭州，浙江大学医学院附属第一医院泌尿外科
  • 收稿日期:2022-05-05 出版日期:2022-08-01
  • 通信作者: 夏丹, 朱清毅, 王林辉
  • 基金资助:
    上海市自然科学基金(18ZR1438400); 上海市卫健委科研课题(20174Y0019)

Feasibility and safety of a novel single-port robotic surgical system in radical prostatectomy: initial experiences

Chao Zhang1, Yong Wei2, Taile Jing3, Zheng Wang1, Chengwu Xiao1, Luming Shen2, Jian Yang2, Ding Peng3, Bo Yang1, Shuo Wang3, Dan Xia3(), Qingyi Zhu2(), Linhui Wang1,†()   

  1. 1. Department of Urology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
    2. Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
    3. Department of Urology, the First Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
  • Received:2022-05-05 Published:2022-08-01
  • Corresponding author: Dan Xia, Qingyi Zhu, Linhui Wang
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引用本文：

张超, 魏勇, 景泰乐, 王正, 肖成武, 沈露明, 杨健, 彭鼎, 杨波, 汪朔, 夏丹, 朱清毅, 王林辉. 国产单孔蛇形臂机器人手术系统在前列腺癌根治术中的初步应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(04): 293-297.

Chao Zhang, Yong Wei, Taile Jing, Zheng Wang, Chengwu Xiao, Luming Shen, Jian Yang, Ding Peng, Bo Yang, Shuo Wang, Dan Xia, Qingyi Zhu, Linhui Wang. Feasibility and safety of a novel single-port robotic surgical system in radical prostatectomy: initial experiences[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(04): 293-297.

目的

探讨国产单孔蛇形臂机器人手术系统用于前列腺癌根治术的安全性和可行性。

方法

2021年10月至2022年4月，海军军医大学第一附属医院、南京医科大学第二附属医院、浙江大学医学院附属第一医院采用国产单孔蛇形臂机器人手术系统完成前列腺癌根治术17例，记录患者一般情况、肿瘤学指标、手术入路、手术时间、操作时间、术中出血量、辅助孔数量、围术期并发症、病理结果、术后一个月PSA及尿控情况等指标。

结果

患者平均年龄（70±7）岁，平均BMI （24.8±2.7） kg/m2，术前平均PSA 11.9（6.6） ng/ml，Gleason评分6分者7例，7分者10例。17例手术均顺利完成，其中经腹腔入路10例，经腹膜外入路7例。5例手术为纯单孔术式，12例手术增加一枚12 mm辅助通道。平均手术时间（210±63）min，主刀医师上机操作时间（172±52）min，术中出血量（115±92）ml，围手术期无输血、肠道损伤、漏尿、发热、切口愈合不良等并发症。术后病理提示Gleason评分6分者4例，7分者12例，9分者1例；T2期14例，T3期3例；切缘阳性者4例（23.5%）。术后1个月平均PSA 0.01（0.074） ng/ml，12例患者尿控满意（71%）。

结论

采用国产单孔蛇形臂机器人手术系统可安全、有效的开展经腹腔和经腹膜外的前列腺癌根治术。

关键词: 机器人, 单孔，腹腔镜, 前列腺癌根治术, 蛇形臂
Objective

To investigate the feasibility and safety of a novel single-port robotic surgical system in radical prostatectomy.

Methods

From October 2021 to April 2022, 17 cases of radical prostatectomy were carried out in the First Affiliated Hospital of Naval Military Medical University, the Second Affiliated Hospital of Nanjing Medical University and the First Affiliated Hospital of Zhejiang University with a novel single-port robotic surgical system. The perioperative information was recorded, such as oncological profiles, surgical approach, operating time, console time, estimated blood loss, number of auxiliary ports, perioperative complications, pathological results, PSA and continence 1 month after operation.

Results

The average age of the patients was (70±7) years old, the average BMI was (24.8±2.7) kg/m2, the average PSA before operation was 11.9(6.6) ng/ml, and the Gleason score was 6 in 7 cases and 7 in 10 cases. All operations were successfully completed, including 10 transperitoneal cases and 7 extraperitoneal cases. Five cases were received pure single-port operation, and in 12 cases, a 12 mm auxiliary port was added. The average operation time was (210±63) minutes, the console time was (172±52) minutes, and estimated blood loss was (115±92) ml. There were no complications observed, such as blood transfusion, colon injury, urinary leakage, fever, poor wound healing and so on. Postoperative pathology showed that Gleason score was 6 in 4 cases, 7 in 12 cases, and 9 in 1 case. Fourteen cases were in T2 stage and 3 cases were T3. There were 4 cases (23.5%) with positive margin. One month after operation, the average PSA was 0.01(0.074) ng/ml, and continence was achieved in 12 cases (71%).

Conclusions

The novel single-port robotic surgical system can be safely and effectively applied in transperitoneal and extraperitoneal radical prostatectomy.

Key words: Robot, Single-port, Laparoscopy, Radical prostatectomy, Deformable surgicalinstruments
图1 蛇形臂在手术中
表1 国产单孔蛇形臂机器人手术系统行前列腺癌根治术中主要指标与代表性达芬奇机器人的比较
组别 发表年份 设备型号 例数 平均/中位手术时间(min) 平均/中位术中出血(ml) Ⅱ级或以上并发症(%) 切缘阳性率(%)
本组 2022 SP 17 210±63 115±92 0 23.5
Kaouk等[29] 2019 SP 3 200(180~210) 70(50~750) 0 66.7
Dobbs等[21] 2019 SP 10 234(191~258) 65(20~150) 0 20
Ng等[30] 2019 SP 20 209±35 296±221 15 55
Steinberg等[31] 2019 SP 15 224±43 198±115 6.7 13
Saidian等[24] 2020 SP 47 256±44 169±114 11 10
Xi/Si 48 275±50 157±125 11 13
Agarwal等[22] 2020 SP 49 161(134~194) 200(75~300) 8 28
Moshovas等[23] 2021 SP 71 114(104~125) 78%a<100 0 12
Xi 71 103(88~111) 51%a<100 0 11
Lenfant等[25] 2021 SP 100 195(174~217) 190(100~250) 12 24
Xi/Si 110 190(171~210) 200(150~300) 5.5 37
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