| Radical Prostatectomy(RP)is the most effective surgical method for the treatment of localized prostate cancer.With the rapid development of technology and the continuous updating of surgical equipment,the introduction of surgical robotic systems has promoted minimally invasive surgery to enter a new era--the era of robotic surgery.The appearance of Robot-assisted Laparoscopic Radical Prostatectomy(RARP)is a milestone in the history of prostate cancer treatment.The First Affiliated Hospital of Nanchang University is the first unit to carry out Davinci robotic surgery in china,which introduced the first Davinci robotic surgery system in Jiangxi Province in December 2014.In the past three years,it ranked the top three in terms of robotic surgery volume in the world.And it ranked the top one in terms of stand-alone surgery volume in 2017 worldwide.By the end of 2019,it had completed more than 500 radical prostatectomy procedures.This study will discuss the technical innovation of robot-assisted laparoscopic radical prostatectomy,the contents of the assistants at the bedside and the clinical research on surgical learning curve,to provide a reference for the upcoming robotic surgery center,and there is no systematic report on the above content.Part ?: Innovative study of robot-assisted laparoscopic radical prostatectomy approachObjectives: Analyze the advantages and disadvantages of various approaches for robot-assisted laparoscopic radical prostatectomy,to carry out innovative research on transvesical robot-assisted radical prostatectomy(TvRARP),and to evaluate the postoperative efficacy of patients.Patients and methods: 35 patients with localized prostate cancer were enrolled for TvRARP.Preoperative data of patients [mean ± SD: patient age 63.4 ± 8.1 years,BMI 28.6 ± 5.3 kg/m2,tPSA 10.8 ± 4.9 ng/ml,prostate volume 30.6 ± 14.4 ml;median(IQR): biopsy Gleason score 6(6,7),and IIEF-5 score 18(16,20)] were collected.Preoperative assessment revealed 28 case of cT2 a and 7 case of cT2 b.All patients were continent preoperatively(defined as no pad required or 1 dry pad per day for precaution).Surgical results and perioperative complications were assessed.All patients were followed up for at least 12 months postoperatively.Results: The mean operation time was 150 ± 35 min.Estimated blood loss was 100 ± 45 ml.Urinary infection was noted in 1 patient and managed with levofoxacin.Another patient complained of nocturia on postoperative day 14 and relieved with solifenacin succinate.Urethral catheters were removed on postoperative day 7.32 patients achieved immediate urinary continence,with 3 patients returning to full continence on postoperative day 14.Postoperative pathology confirmed 24 pT2 a cases,9 pT2 b cases and 2 pT2 c case [Gleason score 6(6,7)].Positive surgical margin was found in 4 patients(11.4%).No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery.Urodynamic studies performed preoperatively and 6 months after surgery: maximal urinary flow [pre-op verse 6 months post-op,12.2(10.2,14.9)ml/s vs 13.7(10.1,15.0)ml/s],bladder capacity [385.3(351.3,410.2)ml vs 370.2(330.1,395.4)ml] and voiding phase detrusor contractility [38.5(27.8,42.3)mmH2O vs 35.6(28.3,41.3)mmH2O].During a minimal of 12-month follow up,no biochemical recurrence was noted in all patients.IIEF-5 score was 17(16,19).Conclusions: The transvesical approach is a valid alternative for RARP in selected patients,providing promising postoperative urinary continence.Long term functional and oncological results requires further investigation.Part ?: The training and cooperation of bedside assistant in robot-assisted laparoscopic radical prostatectomy and its impact on perioperative indicatorsObjective: To rearch the training,preoperative and intraoperative cooperation.of bedside assistant in robot-assisted laparoscopic radical prostatectomy,Analyze and compare the effects of Surgical Outcomes assistants with different years of experience on patients' perioperative outcomes.Methods: Training the bedside assistants,including obtaining qualifications,endoscopic simulation,etc.Carry out the research of bedside assistant‘s surgery preparation,intraoperative cooperation and precautions.Analyze Thirty patients admitted from April 2018 to May 2019 to compare the perioperative indicators of bedside assistants with different laparoscopic surgery experience TvRARP,.Results: Endoscope simulation training improves the operation of bedside assistant.All the 30 operations were successfully completed,without conversion and opening,no blood transfusion cases,and no serious intraoperative and postoperative complications.The total average operation time was 195.8 ± 37.9min,the median total intraoperative blood loss was 150.0(50.0,200)ml;the total average postoperative hospital stay was 7.0 ± 0.3 days,the total surgical margin was 30%,and the postoperative follow-up was 12 Months,an average of 3 months,all patients had no tumor recurrence and death at the last follow-up.According to statistics,the difference in operation time(p = 0.0197)was statistically significant,and the differences in other indicators were not statistically significant.Conclusion: Bedside assistant require systematic training.Experienced bedside assistants(BA)can effectively reduce the operation time and complications.Part ?: Study on the learning curve of robot-assisted laparoscopic radical prostatectomyObjective: To study the learning curve of robot-assisted laparoscopic radical prostatectomy for three different surgical approaches for single surgeon.Methods: The clinical data of 120 patients(50 cases of anterior approach RARP,50 cases of transvesical approach,20 cases of posterior approach RARP)under different surgical approaches for robot-assisted laparoscopic radical prostatectomy in urology at the First Affiliated Hospital of Nanchang University from December 2014 to April 2020 were analyzed to study the RARP learning curve of different surgical approaches under monotherapy.Results: In the anterior approach RARP group,20 patients passed the learning curve after 20 cases,while only 10 cases were under the transvesical approach.The posterior approach RARP needs to be further clarified.Conclusion: The learning curve of robot-assisted laparoscopic radical prostatectomy under different surgical approaches are different.In the length of the learning curve,the transvesical approach < anterior approach < posterior approach group.For physicians with extensive experience in laparoscopic surgery of the urinary system,the anterior approach can reach the plateau after undergoing a learning curve through approximately 20 operations,while approximately 10 cases can be passed through the transvesical approach. |
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