切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜泌尿外科杂志(电子版)

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
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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
[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017[J]. CA Cancer J Clin, 2017, 67(1): 7-30.
[2]
叶定伟，朱耀. 中国前列腺癌的流行病学概述和启示[J].中华外科杂志, 2015, 53(4): 249-252.
[3]
Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent[J]. Eur Urol, 2021, 79(2): 243-262.
[4]
Coughlin GD, Yaxley JW, Chamber SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study[J]. Lancet Oncol, 2018, 19(8): 1051-1060.
[5]
Jazayeri SB, Weissman B, Samadi DB. Outcomes following robotic-assisted laparoscopic prostatectomy: Pentafecta and Trifecta achievements[J]. Minerva Urol Nefrol, 2018, 70(1): 66-73.
[6]
Zattoni F, Montebelli F, Rossanese M, et al. Should radical prostatectomy be encouraged at any age? A critical non-systematic review[J]. Minerva Urol Nefrol, 2018, 70(1): 42-52.
[7]
Kaouk JH, Goel RK, Haber GP, et al. Single-port laparoscopic radical prostatectomy [J]. Urology, 2008, 72(6): 1190-1193.
[8]
Sortino G, Giannubilo W, Di Biase M, et al. Laparoscopic single port radical prostatectomy in the 2020: Why not? Our experience[J]. Urologia, 2021, 88(3): 212-217.
[9]
Wen XQ, Huang WT, Situ J, et al. Single-port laparoscopic radical prostatectomy: initial experience and technical points to reduce its difficulties [J]. Chin Med J (Engl), 2011. 124(23): 4092-4095.
[10]
Kaouk JH, Haber GP, Autorino R, et al. A novel robotic system for single-port urologic surgery: first clinical investigation[J]. Eur Urol, 2014, 66: 1-33-1043.
[11]
张超，王正，张宗勤，等. 国产单孔蛇形臂机器人手术系统在零缺血肾部分切除术中的初步应用[J]. 中华泌尿外科杂志, 2022, 43(2): 81-86.
[12]
Schuessler WW, Schulam PG, Clayman RV, et al. Laparoscopic radical prostatectomy: initial short-term experience[J]. Urology, 1997, 50(6): 854-857.
[13]
Dobbs RW, Magnan BP, Abhyankar N, et al. Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense? [J]. Minerva Urol Nefrol, 2017, 69(4): 313-323.
[14]
Leow JJ, Chang SL, Meyer CP, et al. Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database[J]. Eur Urol, 2016, 70(5): 837-845.
[15]
Du Y, Long Q, Guan B, et al. Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: a system review and meta-analysis[J]. Med Sci Monit, 2018, 24: 272-287.
[16]
Basiri A, de la Rosette JJ, Tabatabaei S, et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? [J]. World J Urol, 2018, 36(4): 609-621.
[17]
Kaouk JH, Goel RK, Haber GP, et al. Single-port laparoscopic radical prostatectomy[J]. Urology, 2008, 72(6): 1190-1193.
[18]
Wei Y, Tang J, Yuan L, et al. Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port[J]. Int Urol Nephrol, 2021, 53(2): 249-255.
[19]
Jiang C, Huang J, Lin T, et al. Extraperitoneal transumbilical laparoendoscopic single-site radical prostatectomy using a homemade single-port device: 20 cases with midterm outcomes[J]. World J Urol, 2014, 32(3): 829-836.
[20]
Kaouk JH, Haber GP, Autorino R, et al. A novel robotic system for single-port urologic surgery: first clinical investigation [J]. Eur Urol, 2014, 66(6): 1033-1043.
[21]
Dobbs RW, Halgrimson WR, Madueke I, et al. Single-port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci SP platform[J]. BJU Int, 2019, 124(6): 1022-1027.
[22]
Agarwal DK, Sharma V, Toussi A, et al. Initial experience with da Vinci single-port robot-assisted radical prostatectomies[J]. Eur Urol, 2020, 77(3): 373-379.
[23]
Moschovas MC, Bhat S, Sandri M, et al. Comparing the approach to radical prostatectomy using the multiport da Vinci Xi and da Vinci SP robots: a propensity score analysis of perioperative outcomes[J]. Eur Urol, 2021, 79(3): 393-404.
[24]
Saidian A, Fang AW, Hakim O, et al. Perioperative outcomes of single vs multi-port robotic assisted radical prostatectomy: a single institutional experience[J]. J Urol, 2020, 204(3): 490-495.
[25]
Lenfant L, Sawczyn G, Aminsharifi A, et al. Pure single-site robot-assisted radical prostatectomy using single-port versus multiport robotic radical prostatectomy: a single-institution comparative study[J]. Eur Urol Focus, 2021, 7(5): 964-972.
[26]
Vigneswaran HT, Schwarzman LS, Francavilla S, et al. A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy[J]. Eur Urol, 2020, 77(6): 671-674.
[27]
Ju GQ, Wang ZJ, Shi JZ, et al. A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System[J]. Asian J Androl, 2021, 23(6): 640-647.
[28]
杜巍，徐伟东，杨悦, 等. 多种路径机器人辅助单孔腹腔镜根治性前列腺切除术的初步疗效[J]. 中华泌尿外科杂志, 2020, 41(11): 815-819.
[29]
Kaouk JH, Bertolo R. Single-site robotic platform in clinical practice: first cases in the USA [J]. Minerva Urol Nefrol, 2019, 71(3): 294-298.
[30]
Ng CF, Teoh JY, Chiu PK, et al. Robot-assisted single-port radical prostatectomy: a phase 1 clinical study [J]. Int J Urol, 2019, 26(9): 878-883.
[31]
Steinberg RL, Johnson BA, Meskawi M, et al. Magnet-assisted robotic prostatectomy using the da Vinci sp robot: an initial case series [J]. J Endourol, 2019, 33(10): 829-834.
[32]
Kaouk J, Valero R, Sawczyn G, et al. Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique [J]. BJU Int 2020, 125(1): 182-189.
[1] 刘伦, 王云鹭, 李锡勇, 韩鹏飞, 张鹏, 李晓东. 机器人辅助膝关节单髁置换术的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 715-721.
[2] 伊喆, 王志新, 陈伟, 齐伟亚, 方杰, 石海飞, 赵夏, 赵喆, 竺枫, 盛伟, 陈焱, 张宇昊, 朱瑾, 殷耀斌, 杨勇, 陈山林, 刘波. 机器人辅助无移位急性舟骨骨折经皮内固定的诊疗与手术操作规范[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 464-468.
[3] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[4] 罗佳, 赵晶晶, 曹小珍, 钟玲, 范林军, 曾令娟. 单侧腋窝双侧乳晕入路机器人甲状腺术后局部加压预防皮下隧道出血的对照研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 603-606.
[5] 刘波, 涂志坚, 李传富, 李江涛, 陈国栋. 机器人解剖性左半肝切除术[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 486-486.
[6] 孟令展, 朱震宇. 达芬奇机器人辅助肝中叶切除术[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 373-373.
[7] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[8] 梅津熠, 王燕, 瞿旻, 董振阳, 周增辉, 沈显琦, 李嘉伦, 高旭. 机器人前列腺癌根治术中"膀胱外中叶"的处理[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 429-433.
[9] 吴少峰, 张轶男, 孙杰. 机器人辅助手术在儿童微创泌尿手术中的应用和展望[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 440-444.
[10] 李腾成, 谭益元, 黄群雄, 吴杰英, 肖恒军, 胡成, 李茂胤, 高新, 狄金明. 机器人腹腔镜后入路完全筋膜内根治性前列腺切除术治疗早期前列腺癌[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 452-456.
[11] 余俊豪, 麻立. 经腹全腹腔镜上尿路尿路上皮癌根治术在临床中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 529-532.
[12] 贾卓奇, 周维茹, 张勇, 张广健, 付军科. 达·芬奇机器人与腹腔镜食管裂孔疝修补术的对比研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 410-414.
[13] 张立鑫, 朱建交, 李敬东. 机器人肝切除技术的优势与劣势[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 477-479.
[14] 嵇晋, 管锦坤, 汪刘华, 王伟, 任俊, 张琪, 王道荣, 马从超. 达芬奇机器人对比腹腔镜在低位直肠癌APR手术中盆底腹膜关闭联合腹膜外造口的应用研究[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 381-387.
[15] 党圆圆, 赵虎林. 机器人辅助小脑齿状核脑深部电刺激植入术[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 320-320.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号