專題討論2:高科技醫療機械人手術

S2-4
Technical Innovations to Optimize Early Return Sex Function after Robotic Assisted Laparoscopic Radical Prostatectomy
歐宴泉主任
台中榮民總醫院泌尿科

Objective
Expanded indications for preoperatively suspicious prostate cancer receiving Prophylactic robotic-assisted laparoscopic radical prostatectomy (RARP) are previously reported. To report the technique modification and refinements of RARP and outcome of urination and sex function after surgery.
Patients and Methods
This retrospective study reviewed data of a subset of 60 potent patients? who underwent RARP for preoperatively suspicious prostate cancer performed by the same surgeon from Feb. 2012 to July 2016. The technique modification and refinements including intrafascial neurovascular bundles (NVBs) preserving with combining retrograde and antegrade high release of NVBs, prostatic artery identification and preserving, endopelvic fascia preservation, puboprostatic ligament and arcus tendenious preservation, bladder neck preservation, precise apical dissection and long urethral length. Continence was defined as the use of ‘no pads’. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual intercourse with or without the use of oral PDE5 inhibitors.
Results
Mean preoperative prostate specific antigen (PSA) was 17.2±3.31ng/mL. The incidence of continence and potency at one-year were reached in 100% and 88.3%. Day of return to continence ranged from day 0 to day 28 (mean: day 12) after removal of urethral catheter. ?Comparisons of preoperative and postoperative urinary function, post-voiding residual urine, symptoms scores and QOL scores were significantly reduced.
Conclusion
Prophylactic RARP with bilateral neurovascular bundle preservation with refined technique can improve urination and sex function by experienced surgeons.