推进阴茎癌的外科治疗:单孔双侧腹股沟淋巴结清扫。

IF 4.5 3区 医学 Q1 UROLOGY & NEPHROLOGY
Sisto Perdonà, Alessandro Izzo, Antonio Tufano, Francesco Passaro, Giuseppe Quarto, Achille Aveta, Roberto Contieri, Savio Domenico Pandolfo, Riccardo Autorino, Gianluca Spena
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引用次数: 0

摘要

作品简介:阴茎癌是一种罕见但具有侵袭性的恶性肿瘤,累及腹股沟淋巴结是一个关键的预后指标(1,2)。NCCN指南建议对未触及淋巴结的中高危患者(pT1b,≥T2)进行预防性腹股沟淋巴结清扫(ILND),旨在早期分期和改善预后(3)。sp方法采用单切口和先进的机器人仪器,以提高可操作性,降低发病率,优化恢复。广泛应用于肾脏和前列腺手术(4,5),据我们所知,这是它在欧洲首次应用于ILND。材料和方法:本视频展示了使用达芬奇SP™系统的新型机器人辅助双侧、浅表和深部ILND。在该患者中,术前3D重建允许对淋巴结和周围结构进行详细的可视化,从而实现精确的解剖和使用Tilepro功能改善术中定位。结果:与开放式技术相比,机器人ILND提供了相似的淋巴结产量,具有更好的美容效果和减少术后疼痛(6)。这些好处被SP系统放大,该系统通过减少器械干扰和提高效率,在受限的腹股沟区域表现出色(7)。更少的切口将伤口感染和皮肤坏死等风险降至最低(8)。SP技术的局限性可能包括延长手术时间,特别是在学习阶段。以及长期肿瘤数据的缺乏。此外,需要同时进行盆腔淋巴结切除术的复杂病例可能需要重新定位机器人系统,从而增加手术时间。结论:SP机器人辅助的ILND结合了肿瘤安全性和降低手术发病率,在阴茎癌的手术治疗方面取得了重大进展。未来的研究需要验证这些发现,比较手术结果,并评估长期疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Advancing Surgical Management of Penile Cancer: Single Port Bilateral Inguinal Lymph Node Dissection.

Introduction: Penile cancer is a rare but aggressive malignancy, with inguinal lymph node involvement representing a key prognostic indicator (1, 2). NCCN guidelines recommend prophylactic inguinal lymph node dissection (ILND) for intermediate-to-high-risk patients (pT1b, ≥T2) with non-palpable nodes, aiming for early staging and improved outcomes (3). The SP-approach employs a single incision and advanced robotic instrumentation to enhance maneuverability, reduce morbidity, and optimize recovery. Widely used in kidney and prostate surgery (4, 5), this is, to our knowledge, its first application for ILND in Europe.

Material and methods: This video shows a novel robotic-assisted bilateral, superficial and deep ILND using the DaVinci SP™ system. In this patient, a preoperative 3D reconstruction allowed detailed visualization of lymph nodes and surrounding structures, enabling precise dissection and an improved intraoperative orientation using Tilepro feature.

Results: Compared to open techniques, robotic ILND offers similar lymph node yields with superior cosmetic outcomes and reduced postoperative pain (6). These benefits are amplified with the SP system, which excels in the constrained inguinal region by minimizing instrument interference and enhancing efficiency (7). Fewer incisions minimized risks such as wound infections and skin necrosis (8). Limitations of the SP-technique might include extended operative times, especially during the learning phase, and the absence of long-term oncological data. Additionally, complex cases requiring concurrent pelvic lymphadenectomy may necessitate repositioning the robotic system, increasing procedure time.

Conclusions: SP robotic-assisted ILND can represent a significant advancement in the surgical management of penile cancer, combining oncological safety with reduced surgical morbidity. Future studies are needed to validate these findings, compare surgical outcomes, and assess long-term efficacy.

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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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