| Background: To explore the c linical effect and value of using adjustable "paper clip" technique to suture the dorsal deep vein complex(DVC)and preserve the functional urethra in robot-assisted laparoscopic radical resection of prostate cancer(RALRP).Methods: 30 cases of RALRP were reviewed,which were all used the adjustable"Paper Clip" technique.The preoperative,intraoperative and postoperative clinical data of 30 patients as well as the follow-up data of postoperative functional recovery were collected.The follow-up time was 1,3,6,12 months after surgery,respectively.Clinical data included:(1)preoperative: age,blood pressure,ethnic ity,smoking history,alcohol consumption history,body mass index(BMI),biopsy pathology Gleason score,prostate volume,prostate-specific antigen(PSA),preoperative international prostate symptom score(IPSS),preoperative urinary continence function evaluation(whether to use a pad);(2)intraoperative: intraoperative time and intraoperative blood loss;(3)postoperative: pathological T stage,whether the tumor broke through the capsule,whether it invaded the seminal ves icle,positive rate of specimen cutting margin,postoperative hospital stay,catheter indwelling time,postoperative complications;(4)follow-up of postoperative functional recovery included:postoperative IPSS score of patients;follow-up time was 1 month,3 months,6months and 12 months after catheter removal;postoperative recovery of urinary control function(pad use);follow-up time was 1 month,3 months,6 months and12 months after catheter removal.IPSS classification: mild(0≤IPSS≤7);(8≤IPSS≤19);severe(20≤IPSS≤35).Patients who did not use any pads or used one pad per day were defined as urinary continence.Statistical methods were analyzed using SPSS version 22.0 for Windows(SPSS Inc.,Chicago,IL,USA).Continuous variables are presented as means and SD,and categorical variables are presented as numbers and percentages.Binary logistic regression analys is was performed to investigate the association between continence recovery and post-operation time.The primary end point was dichotomized between change of pads one time per day and more than one per day.The continence status at 1,3,6 months after surgery were compared to the baseline continence status respectively,adjusting for possible confounders.A nomogram for predicting the1-month,3-month and 6-month incontinent risk and median recovery time was constructed based on the results of COX regression analysis with the pre-operation factors,using the package of rms in R version 3.6.0.The predictive accuracy of this nomogram was measured by the concordance index(C-index).A p-value <0.05 was considered statistically significant.Results: All the 30 RALRP surgeries were successfully completed,among which 1 was reoperated due to postoperative hematuria,and the other 29 patients had no postoperative complications.The average intraoperative blood loss was 123.33±80.66 ml,which was lower than the average intraoperative blood loss reported in the existing literature.After the removal of the catheter after surgery,the patients all showed symptoms of urinary incontinence to varying degrees.57.15% of the patients regained controllability within 1 month after surgery,and the rates of urine control at 3,6 and 12 months increased to92.86%,96.30% and 100%,respectively.Conclusion: The adjustable "Paper Clip" techniques enhance the controllability of suturing the dorsal venous complex in the Robot-assisted laparoscopic radical prostatectomy,which can effectively reduce intraoperative blood loss and improving the urinary continence rate after the operation,which would be helpful for the recovery of patients in some extent. |
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