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Objective:To investigate the efficacy and safety of thulium laser enucleation of the prostate-pre-transection urethral mucosa at the apex of prostate and traditional three lobe enucleation of the prostate for the treatment of benign prostatic hyperplasia patients.Methods:The data of 270 patients with benign prostatic hyperplasia who were underwent ThuLEP-PAM or ThuLEP in our hospital from May 2020 to September 2021 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: ThuLEP-PAM group (120 cases) and ThuLEP group (150 cases). There was no significant difference comparing the age [(69.8±7.7) years vs. (71.4±8.0) years], prostate volume [55.5(41.0, 71.0)ml vs. 58.5(45.0, 80.3)ml], the serum PSA [3.0(1.8, 4.6) ng/ml vs. 3.3(2.1, 5.5)ng/ml], international prostate symptom scores (IPSS) [22(17, 28) vs. 22(17, 27)], the quality of life score (QOL)[5(4, 6) vs. 5(4, 6)], the maximum urinary flow rate (Q max)[5.6(3.5, 7.3)ml/s vs. 5.5(4.0, 7.1)ml/s], the residual urine volume [ 31(0, 81)ml vs. 31(0, 102)ml] between the ThuLEP-PAM group and the ThuLEP group. No significant difference was found between the two groups( P>0.05). In the ThuLEP-PAM group, the external sphincter ring was located firstly, and urethral mucosa at the apex of prostate was circumferentially incised at 5 mm proximal of the sphincter ring by laser. Then the urethral mucosa was incised at the left sulcus beside the verumontanum and the prostate surgical capsule gap was exposed. After the middle lobe was removed, the left and right lobes were removed along the urethral mucosa pre-incision line at the prostatic apex. The ThuLEP group was enucleated by traditional three lobes enucleation. Perioperative indicators and postoperative complications during short-term follow-up were compared between the two groups. Results:All patients successfully completed the operation and the symptoms of the lower urinary tract were significantly improved. Comparison the perioperative factors between ThuLEP-PAM group and ThuLEP group included the following: operative time 90(70, 103)min vs. 83(61, 102)min; enucleated tissue weight 27.0(19.3, 36.5)g vs. 27.0(19.0, 39.0)g; decrease of the hemoglobin 9.9(7.4, 12.4)g/L vs. 9.5(7.1, 12.7)g/L; catheterization time 3.5(3.0, 4.0)d vs. 3.5(3.0, 5.0)d; hospital stay 6.0(5.0, 6.0)d vs. 5.0(4.0, 6.0)d. NO significant difference in these parameters was found between the two groups( P>0.05). There also was no significant difference in PSA[1.1(0.8, 1.5) ng/ml vs. 1.0(0.8, 1.6) ng/ml], IPSS score [5(4, 6) min vs. 5(4, 6)min], QOL score [2(1, 3) vs. 2(1, 3)], Q max [20.9(17.5, 22.5) ml/s vs. 20.4(17.8, 22.7) ml/s] and PVR [0 ml vs. 0(0, 6)ml] between the two groups ( P>0.05) after more than 3 months of follow-up. The incidence of incontinence for ThuLEP-PAM(2 cases)were lower than that for ThuLEP(11 cases)( P=0.031), but there was no significant between the two groups in other complications such as blood transfusion, haematuria, post-voidalurinary retention and urethral stricture. Conclusions:ThuLEP-PAM and ThuLEP have similar effect on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia, both of which have good efficacy and high safety. The biggest advantage of ThuLEP-PAM over ThuLEP is that it reduces the incidence of early postoperative stress urinary incontinence.
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Objective:This paper intends to explore the clinical efficacy and safety of the refined extroperitoneal intrafascial laparoscopic radical prostatectomy in patients with localized prostate cancer.Methods:The data of 107 patients with localized prostate cancer who were underwent laparoscopic radical prostatectomy in our hospital from July 2013 to January 2020 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: the refined intra fascial resection group (59 cases) and the conventional interfascial neurovascular bundle reservation group(48 cases). There was no significant different comparing the age [(61.8±8.9) years vs. (62.2±8.1) years, P=0.71], body mass index (BMI) [(24.8±1.3) kg/m 2 vs.(24.3±1.4) kg/m 2, P=0.89], preoperative total prostate specific antigen (PSA) [(6.8±0.9) ng/ml vs. (7.2±1.1) ng/ml, P=0.44], prostate volume [(47.9±18.4) ml vs. (48.3±17.9) ml, P=0.67] between the modified group and the conventional group. The clinical stage of the two groups was both in cT 1-T 2aN 0M 0, and the preoperative Gleason score was less than or equal to 7 ( P=0.76). In the improved group, the bilateral pelvic floor fascia was not dissected, the dorsal deep vein complex was not sutured, the denonvillier fascia was kept intact, the prostate was dissected by intrafascial technique, and the bilateral vascular and nerve bundles were completely preserved. After anastomosing the urethra and bladder neck, the bilateral prostate fascia, the pubic bladder-prostate ligament, DVC and the anterior wall of bladder neck were continuously sutured with 3-0 barbed wire in order to anatomically reconstructe the anterior suspension system. The preoperative data, intraoperative condition, postoperative pathological stage, positive margin rate and postoperative 6-month's follow-up, especially incontinence and erectile function were compared between the two groups. Results:There was no significant difference between the two groups in the basic clinical data, intraoperative bleeding volume[(90.6±26.4)ml vs.(105.3±34.1)ml, P>0.05], prostate-specific antigen 6 weeks after operation[(0.08±0.06)ng/ml vs.(0.09±0.07) ng/ml, P>0.05], postoperative pathological stage and positive margin rate(12.5% vs. 11.9%, P>0.05). In the early postoperative stage, patients performed a significantly better continence. Continence rate in 1 week: 16.7%(8/48) vs. 52.5%(31/59)( P<0.05), in 1 month: 29.2%(14/48)vs. 64.4%(38/59)( P<0.05), and in 3 month 52.1%(25/48) vs. 77.9%(46/59)( P<0.05). And also a better erectile function recovery rate in 1 month: 8.3%(4/48) vs. 23.7%(14/59)( P<0.05), in 3 month: 27.1%(13/48) vs. 49.2%(29/59)( P<0.05), in refined intrafascial group, but that was not significant different between the two groups 6 months after operation. Conclusion:The refined intrafascial laparoscopic radical prostatectomy can completely reconstruct the anatomic structure adjacent to urethra, and preserve utmostly the pelvic floor muscle, prostate fascia and neurovascular bundle, which are supposed to facilitate the revovery of urinary incontinence and erectile dysfunction in the early postoperative period.
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Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.
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Objective To explore the clinical effect of Habib 4X bipolar radiofrequency ablation assisted laparoscopic partial nephrectomy without blockage of renal artery for treatment of renal cell carcinoma (RCC).MethodsBetween October 2010 and June 2011, 14 patients with exophytic RCC (T1N0M0) were treated with Laparoscopic Partial Nephrectomy with (LRA) or without (LPN) Habib 4X Bipolar Radiofrequency ablation assisted.The LRA group included 6 patients,and the maximum tumor diameter was 2.1 - 3.5 cm (mean,3.1 cm).The LPN group included 8 patients,and the maximum tumor diameter was 2.0 -3.7 cm (mean,3.0 cm).The operative time,average intra-operative blood loss,postoperative hospital stay and incidence of postoperative complications were recorded.Changes of hemoglobin (Hb),serum creatinine (SCr) and ipsilateral glomerular filtration rate (GFR) before and after operation were analyzed and compared. Results The 14 surgical procedures were successful without conversion to open operation.In LRA group,renal artery blocking was unnecessary,the Hb,SCr and GFR before and after operation were (127 ± 19) g/L vs.(124 ± 19) g/L、(96 ±39) μmol/L vs.(92 ±29) μmol/L and (42 ± 12) ml/min vs.(40 ± 13) ml/min,respectively,and the difference was not significant (P ＞0.05).In LPN group,the renal artery blocking time was 20-52 min (mean,32 min),the Hb,SCr and GFR before and after operations were (130±17) g/L vs.(112±15) g/L,(92 ±31) μ mol/L vs.(110±28)μmol/L and (43 ± 14) ml/min vs.(30 ± 11 ) ml/min respectively,and the difference was significant (P ＜0.05 ).The operative time was ( 86 ± 20) min and ( 112 ± 43 ) min,the estimated blood loss was (94 ± 18)ml and (256 ± 58) ml,and the postoperative hospital stay was (5.0 ± 0.8) d and (7.8 ± 1.2 ) d,respectively.The difference between the two groups was significant (P ＜ O.05).Complications such as bleeding,gross hematuria,and leakage of urine were noted in LRA group. Conclusions Habib 4X Bipolar Radiofrequency ablation assisted LPN without blockage of renal artery is a safe and effective intervention with a relatively low incidence of complications.And it is superior to LPN in operative time,intraoperative blood loss and postoperative recovery.