Objective: To compare the clinical effects of single-incision robot-assisted laparoscopic radical prostatectomy (RARP) with and without extraperitoneal special channel device. Methods: The clinical data of 70 patients who had undergone RARP in the Robotic Minimally Invasive Surgery Center of Sichuan Provincial People's Hospital from September 2020 to February 2021 were analyzed retrospectively, including 29 cases who were operated on without special channel device (group A) and 41 cases with special channel device (group B). All operations were performed by robot-assisted single-incision retrograde bladder neck exfoliation via extraperitoneal approach in patients by the same operator. The operation time, intraoperative blood loss, the bladder neck urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, positive rate of incisal margin, indwelling time of urinary catheter, retention rate of postoperative erectile function, satisfaction rate of immediate postoperative urine control, positive rate of postoperative lymph node pathology, incision length, treatment cost and the rate of prostate specific antigen (PSA)lower than 0.2 μg/L at 6 weeks after operation were compared between the two groups. Results: All 70 cases were operated successfully. The difference of age[ (68.9±3.9) vs (69.4±5.4) years], preoperative PSA level[14.1(6.3, 19.8)vs13.7(5.8, 18.1)μg/L], prostate volume[44.8(30.7,172.6)vs 56.3(40.9,163.4)ml ] of the two groups was not statistically significant(all P>0.05). The difference of operation time [ (59.1±18.5) vs (59.6±18.0) min ], intraoperative blood loss [93(66,198)vs 95(68,203) ml ], bladder neck urethral anastomosis time [ (12.6±1.3) vs (13.7±2.8) min ], postoperative hospital stay [ (8.1±2.3) vs (9.1±1.3) d], postoperative exhaust time [ (1.4±0.6) vs (1.3±0.6) d], positive rate of incisal margin (20.7% vs 19.5%), indwelling time of the urinary catheter after operation [ (6.8±1.5) vs (7.1±2.0) d ], the retention rate of postoperative erectile function (31.0% vs 27.0%), the satisfaction rate of immediate postoperative urine control (79.3% vs 75.6%), the positive rate of postoperative lymph node pathology (17.2% vs 14.6%), the length of incision [ (5.1±0.5) vs (6.1±0.4) cm ], the rate of PSA lower than 0.2 μg/L at 6 weeks after operation (86.2% vs 83.0%) of the two groups was not statistically significant(all P>0.05). The operation cost of group A[(62 000±4 000) yuan]was lower than group B[(68 000±4 000) yuan] (P<0.05). Conclusion: Extraperitoneal non-special channel device single-incision RARP is safe and feasible.
目的： 比较腹膜外无专用通道装置与经专用通道装置单切口机器人辅助腹腔镜根治性前列腺切除术（RARP）的疗效。 方法： 回顾性分析四川省人民医院机器人微创中心2020年9月至2021年2月接受RARP的70例患者的临床资料，其中无专用通道装置改良技术（A组）29例，经专用通道装置（B组）41例。所有手术均为同一术者采用机器人辅助经腹膜外途径单切口顺向剥离膀胱颈入路术式完成。术后随访并比较两组的手术时间、术中出血量、膀胱颈尿道吻合时间、术后住院时间、术后排气时间、切缘阳性率、尿管留置时间、术后勃起功能保留率、术后即刻尿控满意率、术后淋巴结病理阳性率、切口长度、治疗费用和术后6周前列腺特异性抗原（PSA）水平。 结果： 70例患者的手术均顺利完成，两组的年龄［（68.9±3.9）比（69.4±5.4）岁］、术前PSA水平［14.1（6.3，19.8）比13.7（5.8，18.1）μg/L］和前列腺体积［44.8（30.7，172.6）比 56.3（40.9，163.4）ml］差异均无统计学意义（均P>0.05）。两组的手术时间［（59.1±18.5）比（59.6±18）min］、术中出血量［93（66，198）比95（68，203）ml］、膀胱颈尿道吻合时间［（12.6±1.3）比（13.7±2.8）min］、术后住院时间［（8.1±2.3）比（9.1±1.3）d］、术后排气时间［（1.4±0.6）比（1.3±0.6）d］、切缘阳性率（20.7%比19.5%）、术后尿管留置时间［（6.8±1.5）比（7.1±2）d］、术后勃起功能保留率（31.0%比27.0%）、术后即刻尿控满意率（79.3%比75.6%）、术后淋巴结病理阳性率（17.2%比14.6%）、切口长度［（5.1±0.5）比（6.1±0.4）cm］、术后6周PSA≤0.2 μg/L者占比（86.2%比83.0%）的差异均无统计学意义（均P>0.05）。A组手术费用［（6.2±0.4）万元］低于B组［（6.8±0.4）万元］（P<0.05）。 结论： 腹膜外无专用通道装置改良技术单切口RARP安全可行。.