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Preliminary comparability of the modified extraperitoneal free-PORT single incision method and transabdominal multi-incision robot-assisted laparoscopic radical prostatectomy

Normal info

A complete of 259 sufferers with RARP have been enrolled on this research, and all operations have been carried out by the identical surgeon. Among the many sufferers, there have been 147 circumstances involving no particular PORT extraperitoneal single-incision RARP (Group A) and 112 circumstances involving a number of incisions by transperitoneal technique RARP (Group B). The research was authorized by the Ethics Committee of Sichuan Provincial Individuals’s Hospital, and all topics or their kin signed knowledgeable consent kinds.

The operation technique

With out particular PORT extraperitoneal single-incision RARP (Group A)

channel institution

With the affected person within the Trendelenburg place after common anesthesia, the bottom level of the arc incision was taken from the anterior midline to five cm on the pubic symphysis, and a pair of.5 cm on each side of the 7–8 cm midline from the pubic symphysis was used because the arc incision at each ends (Fig. 1A). The pores and skin and subcutaneous tissue have been lower in flip, the house between the subcutaneous tissue and the rectus abdominis was absolutely freed, and the pores and skin flap was turned to the cephalic facet and pulled. The anterior sheath of the rectus abdominis was lower longitudinally on the midpoint of the incision at 7–8 cm from the pubic symphysis, 2.5 cm was prolonged upwards, and the fingers have been positioned into the blunt separation of the rectus abdominis and the peritoneal house. The extraperitoneal house was dilated with a do-it-yourself balloon, and 900 ml gasoline was injected into the balloon for 10 s. The extraperitoneal house was examined, and a 12 mm trocar was positioned near the anterior sheath incision (Fig. 1B). The anterior sheath of the rectus abdominis was sutured to take care of airtightness, the house was inflated, and the lens was inserted for remark. The decrease fringe of the arc incision was pulled, the 12 mm trocar was positioned at 3–4 cm above the pubic symphysis beneath direct imaginative and prescient, each ends of the arc incision have been pulled, and two robotic steel puncture kits have been positioned at 3–4 cm on each side of the midline (Fig. 1C). The da Vinci Si robot-assisted laparoscopic surgical procedure system was related (Fig. 1D). The distal finish was the lens gap, and the proximal finish was the auxiliary gap.

Determine 1

Institution of a single-incision RARP channel with a modified extraperitoneal method.

Operation procedures

A 30-degree upwards visible subject was used to show the pubic symphysis space and Retzius house, free and take away the fats on the floor of the prostate, lower open the bilateral intrapelvic fascia and expose the deep dorsal vein advanced of the penis (dorsal vascular advanced, DVC) and pubic prostatic ligament. The junction with the prostate bladder was separated and lower by monopolar electrical scissors. After confirming the posterior wall of the bladder neck and center lobe of the prostate, the posterior wall of the bladder neck was lower open, and the muscle mass between the bottom of the prostate and detrusor of the bladder have been recognized for sharp separation to show the vas deferens and seminal vesicles. The seminal vesicles have been fully uncovered after the bilateral vas deferens have been severed (Fig. 2). The Denonvilliers’ Fascia was lower, and the dorsal facet of the prostate was separated to the apex of the prostate. In all circumstances, the vascular nerve bundle was reserved. The lateral ligament of the prostate was ligated with HEM-O-LOK and severed. The DVC was repeatedly sutured with 2-0 barbed wire, and the sutures have been quickly left uncut and positioned on the left facet of the hole. The urethra was resected after dissociating the tip of the prostate, and the urethral size 1.5–2.0 cm was preserved. The bladder neck and urethra have been repeatedly anastomosed with 2-0 double needle inverted needle thread from the posterior lip of the bladder neck. A 20F three-cavity catheter was retained. The suture of the DVC was lower and ligated after the water injection check, which confirmed that there was no urine leakage and no energetic bleeding. After eradicating the instrument, the prostate specimen was eliminated via an arc single incision, a plasma drain was positioned on the web site of the vesicourethral anastomosis, and the incision was sutured layer by layer.

Determine 2
figure 2

The seminal vesicles have been fully uncovered after the bilateral vas deferens have been severed.

A number of incisions by transperitoneal technique RARP (Group B)

channel institution

After common anesthesia, the disposable 12 mm cannula was positioned on the higher fringe of the navel, and the robotic laparoscope was positioned. Beneath direct imaginative and prescient, an 8 mm robotic steel cannula was positioned 1.5–2.0 cm beneath the extent of the paraumbilical area of the best left lateral rectus abdominis and eight–10 cm from the lens gap. The No. 1 and No. 2 mechanical arms have been positioned.

The 8 mm casing was positioned 1.5–2.0 cm above the No. 2 manipulator, and the No. 3 manipulator was positioned on the left axillary entrance line of the No. 2 arm 8–10 cm. The 12 mm cannula was positioned because the helper gap 4 cm on the best facet of the umbilical airplane lens gap and 4 cm on the skin of the best mechanical arm, and the operation was carried out utilizing a transperitoneal strategy (Fig. 3).

Determine 3
figure 3

“A” exhibits a lens cannula, “B” exhibits a No. 2 arm cannula, “C” exhibits a No. 3 arm cannula, “D” exhibits a No. 1 arm cannula, “E” exhibits an incision for eradicating a specimen with a transperitoneal strategy, “F and G” present auxiliary cannulas, and “H” exhibits an incision via an extraperitoneal single-hole pathway.

Operation procedures

First, the seminal vesicle gland and vas deferens have been dissociated, the Dirichlet house was established, and the house was crammed with gauze as a mark. With the inverted U-shaped peritoneal incision alongside the median umbilical ligament, the anterior bladder house was entered, the fascia across the prostate and so far as the tip was freed, the intrapelvic fascia was opened, each side of the prostate have been dissociated till the deep dorsal vein advanced (dorsal vein advanced, DVC) was clearly uncovered, and the pubic prostatic ligament was retained. After amputation of the bladder neck (Fig. 4), the lateral prostatic ligament was dissected, and the bilateral ligament was ligated. All of them have been tied to protect the neurovascular bundle on the tip of the prostate. The prostate was fully eliminated after chopping the DVC with 2-0 absorbable sutures. After the bladder neck was anastomosed to the urethra, a 20F three-lumen catheter was retained. After making certain that there was no water leakage on the anastomosis, the specimen was faraway from the instrument, a plasma drain was positioned on the web site of the vesicourethral anastomosis, and the incision was sutured layer by layer.

Determine 4
figure 4

Amputation of the bladder neck.

Statement index

The operation time, intraoperative blood loss, postoperative hospital keep, postoperative exhaust time, optimistic price of incisal margin, indwelling time of urinary catheter, erectile operate, fast urine management satisfaction price (24 h utilizing urine pad was ≤ 1 as urine management satisfaction price ), postoperative 3-month urine management satisfaction price, postoperative lymph node pathology, incision size and biochemical recurrence price have been in contrast between the 2 teams.

Statistical strategies

SPSS 21.0 software program was used to enter and analyze the information. Age, operation time, postoperative hospital keep, postoperative exhaustion time, catheter indwelling time and incision size have been noticed to be in accordance with a traditional distribution, expressed as “x ± s,” and in contrast between the 2 teams by impartial pattern t check. PSA, prostate quantity and intraoperative bleeding quantity had skewed distributions, expressed by M (Q1 and Q3), and the Mann‒Whitney U check was used to check the 2 teams. The adoption price/constituent ratio, frequency of labeled knowledge reminiscent of Gleason rating, BMI, scientific stage, pathological stage, historical past of decrease stomach operation, lymph node dissection, optimistic innovative, preservation of erectile operate after operation, passable urine management instantly after operation, passable urine management 3 months after operation, optimistic lymph node pathology and biochemical recurrence 3 months after operation (PSA was increased than 0.2 ng/mL), and chi-square check have been used to check between teams (two-sided check, check degree α = 0.05).

Declaration

This research complies with the rules of the Helsinki Declaration and the related moral necessities of Sichuan Academy of Medical Sciences and Sichuan Provincial Individuals’s Hospital (ethics No. 100, 2020).

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