Abstract:Objective: To summarize the experience in the earliest robotic-assisted laparoscopic surgery in urology and discuss its applied value. Methods: 500 patients underwent robot-assisted laparoscopic urological surgery during 2007 October to 2013 November. Results: 497 of 500 cases were operated successfully. The upper tract surgery was performed on 135 cases, accounting for 27.16%, including 2 cases of adrenalectomy (0.4%), 60 cases of partial nephrectomy (12.07%), 37 cases of radical nephrectomy (7.44%), 6 cases of nephroureterectomy (1.21%), 3 cases of unroofing of cyst of kidney (0.6%), 11 cases of pyeloplasty (2.21%), 14 cases of ureterovesical reimplantation (2.82%), 1 case of ureterolysis (0.2%), and 1 case of resecction of ureteral stenosis and ureteral anastomosis (0.2%). The lower urinary surgery was performed on 362 cases, accounting for 72.84%, including 319 cases of prostatectomy (64.19%), 24 cases of radical cystectomy and ileal conduit (4.83%), 7 cases of radical cystectomy and neobladder (1.41%), 3 cases of ureterocutaneostomy (0.6%), 3 cases of pelvic neoplasm resection (0.6%), 4 cases of excision of seminal vesicle neoplasm (0.8%), 1 case of lithotripsy of bladder calculus (0.2%), and 1 case of sacrocolpopexy (0.2%). Three cases were converted to open surgery (0.6%), including the retroperitoneal fibrosis release in 1 case, radical prostatectomy in 1 case, and cystectomy in 1 case. All the patients recovered without any complication. Conclusions: Following the principles and dissecting anatomical surface of open and laparoscopic surgery, the robotic-assisted laparoscopic surgery is safe and effective technically, and can gain satisfied clinical treatment outcomes, with the many advantages such as with a small trauma, clear operation field, less blood loss and short learning curve.
[1] 张旭,丁强.机器人技术的沿革与展望.微创泌尿外科杂志,2013,2(4):225-226. [2] Babbar P, Hemal AK. Robot-assisted urologic surgery in 2010-Advancements and future outlook. Urol Ann, 2011,3(1):1-7. [3] Ficarra V, Cavalleri S, Novara G, et al. Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol, 2007,51(1):45-55. [4] Lavery HJ, Small AC, Samadi DB, et al. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS, 2011,15(3):291-297. [5] Benway BM, Wang AJ, Cabello JM, et al. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol, 2009,55(3):592-599. [6] Coelho RF, Palmer KJ, Rocco B, et al. Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol, 2010,57(6):945-952. [7] Gupta NP, Nayyar R, Hemal AK, et al. Outcome analysis of robotic pyeloplasty: a large single-centre experience. BJU Int, 2010,105(7):980-983. [8] Braga LH, Pace K, DeMaria J, et al. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol, 2009,56(5):848-857. [9] Wang AJ, Bhayani SB. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. Urology,2009,73(2):306-310. [10] Liberman D, Trinh QD, Jeldres C, et al. Is robotic surgery cost-effective: yes. Curr Opin Urol, 2012,22(1):61-65. [11] Lotan Y. Is robotic surgery cost-effective: no. Curr Opin Urol, 2012,22(1):66-69. [12] Boger M, Lucas SM, Popp SC, et al. Comparison of robotassisted nephrectomy with laparoscopic and hand-assisted laparoscopic nephrectomy. JSLS, 2010,14(3):374-380.