Lateral Approach in Robotic-Assisted Radical Prostatectomy: Introducing Gaston's Technique in Brazil.

IF 4.5 3区 医学 Q1 UROLOGY & NEPHROLOGY
Plinio Ramos Pinto, Thiago Camelo Mourão, Jayme Quirino Caon Nobre, Rodrigo Coelho Pde Carvalho, João Pedro Soares Nunes, Walter Henriques da Costa, Richard Pierre Gaston, Stenio C Zequi
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引用次数: 0

Abstract

Introduction: Prostate cancer is one of the most common malignancies in men, significantly impacting quality of life and survival (1, 2). Radical prostatectomy remains a key treatment for localized disease, with ongoing advancements in surgical techniques (3-5). The lateral approach in robotic-assisted prostatectomy was developed by Professor Richard Gaston and has emerged as a method designed to enhance anatomical preservation and functional outcomes, aligning with the growing demand for precision in prostate cancer management (6-8).

Objective: To present for the first time in Brazil the step-by-step technique and initial experience with the lateral approach to radical prostatectomy, emphasizing its safety, feasibility, and reproducibility as a novel surgical option for prostate cancer treatment.

Materials and methods: This video demonstrates a lateral approach to radical prostatectomy in a 51-year-old male patient diagnosed with localized prostate cancer (Gleason 7 (3+4) in 2 out of 17 fragments). The surgical procedure was performed using a transperitoneal robotic approach, with lateral entry via the right paravesical space to optimize access and exposure of pelvic structures. Key technical steps included precise dissection of the endopelvic fascia, early identification and preservation of neurovascular bundles, and bladder neck preservation to enhance postoperative functional outcomes. Hemostasis was achieved using selective bipolar energy and clips, and urethrovesical anastomosis was performed using a running suture technique with barbed sutures.

Results: The surgery was performed without complications, with an operative time of 150 minutes and estimated blood loss of 100 mL. The patient was discharged on the first postoperative day with adequate pain control. The urinary catheter was removed on the seventh postoperative day, and the patient reported complete continence from catheter removal onwards, requiring no pads. At three-month follow-up, the patient continued to report full urinary continence and satisfactory erectile function with phosphodiesterase type 5 inhibitors. His PSA levels remained undetectable at 3 and 6 months postoperatively.

Conclusions: The lateral approach to radical prostatectomy represents a safe and reproducible technique for localized prostate cancer treatment. To our knowledge, this is the first reported case of this approach performed in Brazil, marking an important step in expanding surgical options for prostate cancer. Further studies are required to evaluate long-term clinical outcomes and comparative benefits.

外侧入路在机器人辅助根治性前列腺切除术中的应用:在巴西介绍Gaston技术。
简介:前列腺癌是男性最常见的恶性肿瘤之一,显著影响生活质量和生存(1,2)。随着手术技术的不断进步,根治性前列腺切除术仍然是局部疾病的关键治疗方法(3-5)。机器人辅助前列腺切除术中的侧入路是由Richard Gaston教授开发的,作为一种旨在提高解剖保存和功能结果的方法,与前列腺癌治疗日益增长的精确度需求相一致(6-8)。目的:在巴西首次介绍侧入路根治性前列腺切除术的分步技术和初步经验,强调其作为前列腺癌治疗的一种新型手术选择的安全性、可行性和可重复性。材料和方法:这段视频展示了一位51岁男性患者的侧路根治性前列腺切除术,诊断为局限性前列腺癌(17个碎片中有2个Gleason 7(3+4))。手术采用经腹膜机器人入路,通过右侧膀胱旁间隙外侧入路,以优化骨盆结构的进入和暴露。关键技术步骤包括精确解剖盆腔内筋膜,早期识别和保存神经血管束,以及保存膀胱颈以提高术后功能预后。采用选择性双极能量和夹子止血,输尿管吻合术采用倒刺缝合术。结果:手术无并发症,手术时间150分钟,估计失血量100 mL。患者术后第一天出院,疼痛得到充分控制。术后第7天拔除导尿管,患者报告自拔除导尿管后完全尿失禁,无需垫尿。在3个月的随访中,患者继续报告完全尿失禁和5型磷酸二酯酶抑制剂令人满意的勃起功能。术后3个月和6个月PSA水平仍未检测到。结论:侧入路根治性前列腺切除术是一种安全、可重复的治疗局限性前列腺癌的技术。据我们所知,这是巴西首次报道的这种方法,标志着扩大前列腺癌手术选择的重要一步。需要进一步的研究来评估长期临床结果和比较效益。
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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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