Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated...Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.展开更多
[目的]比较机器人辅助下经皮髋臼前柱顺行螺钉内固定术,与传统徒手经皮螺钉内固定治疗髋臼骨折的临床疗效。[方法]回顾性分析2018年1月—2021年9月在本院采用经皮置钉固定髋臼前柱骨折24例患者的临床资料。根据术前医患沟通结果,12例采...[目的]比较机器人辅助下经皮髋臼前柱顺行螺钉内固定术,与传统徒手经皮螺钉内固定治疗髋臼骨折的临床疗效。[方法]回顾性分析2018年1月—2021年9月在本院采用经皮置钉固定髋臼前柱骨折24例患者的临床资料。根据术前医患沟通结果,12例采用机器人辅助置钉,12例采用传统徒手置钉。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,术中无神经、血管损伤等严重并发症。两组手术时间的差异无统计学意义(P>0.05),机器人组置钉时间[(32.5±7.2) min vs (57.6±11.9) min, P<0.05]、导针调整次数[(0.5±0.5)次vs (6.8±1.1)次, P<0.05]、射线曝光时长[(23.0±7.6) s vs(78.5±13.7) s, P<0.05]、术中透视次数[(14.9±4.0)次vs (52.9±8.6)次, P<0.05]、术中出血量[(32.0±9.0) ml vs (74.8±19.5) ml, P<0.05]均显著少于徒手组,两组切口愈合等级及住院时间的差异无统计学意义(P>0.05)。两组均获随访12个月以上,两组恢复下地行走时间及完全负重活动时间的差异均无统计学意义(P>0.05)。随时间推移,两组VAS评分均显著减少(P<0.05),而Majeed评分均显著增加(P<0.05);相应时间点,两组间VAS评分和Majeed评分的差异均无统计学意义(P>0.05)。影像方面,与术后即刻相比,末次随访时,两组Matta评级、内固定位置均无显著改变(P>0.05)。两组影像骨折愈合时间的差异无统计学意义(P>0.05)。[结论]与传统徒手手术相比,机器人辅助下经皮髋臼前柱顺行螺钉内固定术置钉更精准,术中射线暴露量更低,组织损伤更小,临床效果稳定。展开更多
Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a cont...Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.展开更多
基金This study is supported by the Shanghai“Top Priority”Medical Center Project(No.2017ZZ01005)the National Natural Science Foundation of China(Youth Grant,No.81502198)the Shanghai Pujiang Talent Project(No.15PJD001).
文摘Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.
文摘[目的]比较机器人辅助下经皮髋臼前柱顺行螺钉内固定术,与传统徒手经皮螺钉内固定治疗髋臼骨折的临床疗效。[方法]回顾性分析2018年1月—2021年9月在本院采用经皮置钉固定髋臼前柱骨折24例患者的临床资料。根据术前医患沟通结果,12例采用机器人辅助置钉,12例采用传统徒手置钉。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,术中无神经、血管损伤等严重并发症。两组手术时间的差异无统计学意义(P>0.05),机器人组置钉时间[(32.5±7.2) min vs (57.6±11.9) min, P<0.05]、导针调整次数[(0.5±0.5)次vs (6.8±1.1)次, P<0.05]、射线曝光时长[(23.0±7.6) s vs(78.5±13.7) s, P<0.05]、术中透视次数[(14.9±4.0)次vs (52.9±8.6)次, P<0.05]、术中出血量[(32.0±9.0) ml vs (74.8±19.5) ml, P<0.05]均显著少于徒手组,两组切口愈合等级及住院时间的差异无统计学意义(P>0.05)。两组均获随访12个月以上,两组恢复下地行走时间及完全负重活动时间的差异均无统计学意义(P>0.05)。随时间推移,两组VAS评分均显著减少(P<0.05),而Majeed评分均显著增加(P<0.05);相应时间点,两组间VAS评分和Majeed评分的差异均无统计学意义(P>0.05)。影像方面,与术后即刻相比,末次随访时,两组Matta评级、内固定位置均无显著改变(P>0.05)。两组影像骨折愈合时间的差异无统计学意义(P>0.05)。[结论]与传统徒手手术相比,机器人辅助下经皮髋臼前柱顺行螺钉内固定术置钉更精准,术中射线暴露量更低,组织损伤更小,临床效果稳定。
文摘Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.
