Abstract
Objective of the study. To evaluate results of robot-assisted laparoscopic radical prostatectomy in the framework of a surgeon’s learning curve; to evaluate the effect of reconstruction of the ligamentous apparatus of the lower pelvis on early recovery of urine retention.Materials and methods. 246 patients were divided into 3 groups depending on the surgery date. The analyzed data was accumulated prospectively and retrospectively. Preoperative characteristics (TNM stage, PSA, ISUP), intraoperative characteristics (surgical time, blood loss volume, surgery type and character, type of reconstruction of the ligamentous apparatus of the lower pelvis) and postoperative characteristics (duration of bladder drainage with a urethral catheter, level and time of recovery for urine retention and erectile function) were evaluated. Reconstruction of the ligamentous apparatus of the lower pelvis was performed through reconstruction of the Denonvillier fascia (Rocco stitch), as well as through suturing fibers of the bladder neck with periurethral tissues and residual puboprostatic ligaments for stabilization of the urethrovesical complex.Results. All operations were successfully completed without conversions or transfusions. Median surgical time was 160 minutes (p = 0.0001). Median blood loss was 173.3 cm3 (p = 0.0002). Mean prostatic volume was 36 cm3 (29–47.5 cm3), and overall frequency of positive surgical margin was 12.82 %. Overall frequency of urine retention recovery was 51.6 % after 3 months, 63.7 % after 6 months (p >0.05). In the patient group with reconstruction of the ligamentous apparatus of the lower pelvis, frequency of urine retention recovery was higher than in the group without reconstruction: 64.1 % vs 45.3 % (after 3 months, р = 0.041) and 74.7 % vs 62.3 % (after 6 months, р = 0.034). Conclusion. Surgical time, blood loss were significantly decreased with the number of performed operative interventions. Significant improvement of early urine retention recovery was observed in the patient group with reconstruction of the ligamentous apparatus of the lower pelvis.
Highlights
Институт урологии и репродуктивного здоровья человека ФГАОУ ВО «Первый Московский государственный медицинский университет им
Reconstruction of the ligamentous apparatus of the lower pelvis was performed through reconstruction of the Denonvillier fascia (Rocco stitch), as well as through suturing fibers of the bladder neck with periurethral tissues and residual puboprostatic ligaments for stabilization of the urethrovesical complex
Blood loss were significantly decreased with the number of performed operative interventions
Summary
1. Цель исследования – оценить результаты робот-ассистированной лапароскопической радикальной простат эктомии в рамках кривой обучения одного хирурга; оценить влияние реконструкции опорно-связочного аппарата малого таза на раннее восстановление удержания мочи. Оценивались предоперационные показатели (стадия по TNM, ISUP, простатический специфический антиген), интраоперационные показатели (длительность операции, объем кровопотери, вид и характер операции, тип реконструкции опорно-связочного аппарата малого таза) и послеоперационные показатели (длительность дренирования мочевого пузыря уретральным катетером, степень и сроки восстановления удержания мочи и эректильной функции). В группе пациентов с реконструкцией опорно-связочного аппарата малого таза частота восстановления удержания была выше по сравнению с группой без реконструкции: 64,1 % vs 45,3 % (через 3 мес, р = 0,041) и 74,7 % vs 62,3 % (через 6 мес, р = 0,034). Отмечено значимое улучшение показателей раннего восстановления удержания мочи в группе с выполнением реконструкции опорно-связочного аппарата малого таза.
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