The atlas of supine single port extraperitoneal access.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY
Luca Lambertini, Matteo Pacini, Luca Morgantini, Jhon Smith, Juan Ramon Torres-Anguiano, Simone Crivellaro
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Abstract

Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1-3). Nevertheless, a comprehensive description of different supine access options is still lacking (4-6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes.

Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space.

Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%.

Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning.

仰卧单孔腹膜外入路图集。
简介:单孔(SP)平台的问世为泌尿外科领域开辟了新的手术选择,可在腹膜外和患者仰卧位进行大型泌尿外科机器人辅助手术(1-3)。然而,目前仍缺乏对不同仰卧入路选择的全面描述(4-6)。有鉴于此,我们提供了腹腔镜腹膜外仰卧位入路选择的分步指南,并探讨了初步的手术效果:经膀胱入路是在耻骨上方 3 厘米处横向切口,在腹部前片切口后,用柔性膀胱镜对膀胱充气,并在膀胱穹隆水平切开逼尿肌。同样,腹膜外入路也是在耻骨上方切开一个 4 厘米的切口,在看到腹膜前间隙后,轻轻展开腹膜前脂肪。在麦克伯尼点处切开一个 3 厘米的切口,进行低位前方入路,然后展开腹部肌肉。结果:结果:总共为 623 名患者实施了 16 种不同的仰卧腹膜外入路手术。没有发生术中转换。经膀胱入路、腹膜外入路和低位前入路的中位入路时间分别为 16 分钟(IQR 12-21)、11 分钟(IQR 7-14)和 14 分钟(IQR 10-18)。值得注意的是,81.5% 的患者当天出院,术后无阿片类药物使用率为 73%:该图集提供了一个全面的分步指南,可帮助患者在腹膜外和仰卧位成功实施所有主要的泌尿外科 SP 手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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