导读

今天与大家分享的文章发表于European Urology，第一作者来自克利夫兰诊所，据作者描述，这是首项进行机器人单孔经膀胱前列腺部分切除术的临床报告[1]。小编翻译了部分内容，希望对您有所帮助。

Single-port Robotic Transvesical Partial Prostatectomy for Localized Prostate Cancer: Initial Series and Description of Technique

机器人单孔经膀胱前列腺部分切除术治疗局限性前列腺癌：最初的系列研究和技术描述

Introduction

介绍 

Magnetic resonance imaging (MRI) combined with targeted prostate biopsy has improved detection and localization of clinically significant prostate cancer. A transperineal approach to prostate biopsy possibly confers further improvement in diagnostic accuracy. While wholegland treatments may be associated with treatment regret related to morbidity, many patients reach for therapeutic options that minimize adverse effects. 

磁共振成像（MRI）与靶向前列腺活检相结合，改善了临床显著性前列腺癌的发现和定位。经阴部前列腺活检可能会进一步提高诊断的准确性。虽然全腺体治疗可能出现不良事件，使患者后悔接受全腺体治疗，但许多患者都希望接受不良反应最少的治疗方案。

Focal therapy in the form of high-intensity focused ultrasound (HIFU) has emerged as an acceptable treatment option for appropriately selected men with localized low and intermediate-risk disease, and may have reduced the risk of post-treatment incontinence and impotence compared with radical prostatectomy. By International Delphi Consensus, these men should have good life expectancy, prostate MRI showing suspicious lesions with histologic confirmation, as well as MRI-visible Gleason 7 prostate cancer localized to a treatable location. 

对于低危和中危局限性前列腺癌患者，高强度聚焦超声（HIFU）局灶治疗是一种可接受的治疗方案，与根治性前列腺切除术相比，可能降低了治疗后尿失禁和阳痿的风险。根据国际德尔菲共识，适合接受HIFU局灶治疗的患者应具有良好的预期寿命，前列腺MRI显示有可疑病变并经组织学检查确认，以及MRI显示Gleason 7前列腺癌且病变位置可治疗。

While focal ablation has garnered significant interest in the last decade, partial prostate excision for prostate cancer has been studied sparingly. Feasibility of partial prostatectomy has been demonstrated in a single patient with a bladder neck paraganglioma with prostatic involvement. Another series evaluated anterior partial prostatectomy in patients with anterior prostate cancer not accessible to focal ablation. This study found that anterior partial prostatectomy was safe and feasible with good functional results, although it was associated with a significant positive margin rate of 53%. In 2021, Sood et al. described precision prostatectomy as safe and feasible, with removal of all but a thin rim of tissue overlying the neurovascular bundle on the contralateral side of the dominant lesion. In these patients, a transperitoneal, anterior approach is utilized, similar to traditional nerve-sparing prostatectomy.

虽然局灶消融术在过去十年中获得了极大的关注，但关于前列腺癌部分切除术的研究却少之又少。有研究对一例膀胱颈副神经节瘤伴前列腺受累的患者进行了前列腺部分切除术，证明了前列腺部分切除的可行性。另一项系列研究在无法接受局灶消融且前列腺癌位于前列腺前部的患者中评估了前列腺前部切除术。该研究发现，前列腺前部切除术安全可行，功能结局良好，但阳性切缘率有53%。2021年，Sood等人描述了安全可行的精确前列腺切除术，除了病变对侧的神经血管束上的一圈薄薄的组织外，其余都被切除。在这些患者中，使用了经腹膜前方入路，类似于传统的保留神经的前列腺切除术。

The daVinci single-port (SP) robot has allowed for recent adaptation to a transvesical approach to radical prostatectomy and simple prostatectomy (Fig. 1). In our experience, the SP transvesical approach has been associated with less overall morbidity, including decreased opioid prescription requirements, outpatient surgery, and shorter catheter duration. Furthermore, the SP transvesical approach allows for versatile access to the prostate gland without disruption of the space of Retzius. In 2018, our group published a preclinical study demonstrating technical feasibility of SP transvesical partial prostatectomy[2].

随着达芬奇单孔（SP）机器人的发明，现在可以进行经膀胱根治性前列腺切除术和单纯前列腺切除术（图1）。根据经验，SP经膀胱前列腺切除的整体不良事件发生率更低，阿片类药物需求更少，可进行门诊手术，导尿管留置时间更短。此外，SP经膀胱途径可以在不破坏耻骨后间隙的情况下接近前列腺。2018年，我们小组发表了一项临床前研究[2]，证明了SP经膀胱前列腺部分切除术的技术可行性。

Fig. 1 Single-port transvesical approach utilized for partial prostatectomy. The transvesical approach allows for direct access to the prostatic urethra, facilitating hemigland excision of (A) the anterior prostate, (B) the lateral lobe, or (C) a specific tumor location.

图1 单孔经膀胱前列腺部分切除术。经膀胱入路可直接进入前列腺部尿道，便于对（A）前列腺前部、（B）侧叶或（C）特定肿瘤位置进行半切除。

In this manuscript, we describe a technique for partial prostate gland excision through a novel transvesical approach and replicate the inclusion criteria for focal therapy. We report the initial perioperative outcomes in the first nine consecutive patients to undergo this procedure at our institution.   

本文描述了一种经膀胱入路进行前列腺部分切除的新型技术，患者标准与局灶治疗相同。报告了首批9例连续接受该手术的患者的围手术期初步结局。

Patients and methods

患者和方法

Inclusion and exclusion criteria

纳入和排除标准

The inclusion criteria were low- or intermediate-risk disease (Gleason 7), organ-confined disease, and preoperative MRI without evidence of locally advanced or metastatic disease. While the inclusion criteria duplicated the HIFU prostate focal therapy program at our institution, we expanded the inclusion criteria to include patients excluded from HIFU such as those with anteriorly located tumors, significant prostatic calcifications, obliteration of prostatorectal junction, and prostate size larger than 80 cc on preoperative MRI. Patients were excluded if positive biopsy cores did not correspond to suspicious prostate MRI lesions. Patients with bilateral positive biopsies, multiquadrant suspicious nodules or signs of locally invasive disease on MRI, and >100 g prostate volume were excluded from this approach.

纳入标准是低危或中危（Gleason 7）、器官局限性前列腺癌，以及术前MRI显示没有局部晚期或转移性疾病。虽然纳入标准与我们机构的HIFU前列腺局灶治疗一样，但我们扩大了纳入标准，包括了那些不适合接受HIFU的患者，如肿瘤位于前列腺前方、明显的前列腺钙化、前列腺直肠交界处模糊，以及术前MRI显示前列腺尺寸大于80cc。患者排除标准为阳性活检核芯与MRI显示的可疑病变不一致、双侧阳性活检、多象限可疑结节或MRI显示有局部浸润性疾病迹象、以及前列腺体积>100 g。

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Technical aspects

技术层面

Patients are positioned in the lithotomy position, and kept either flat or in minimal Trendelenburg position based on body habitus (Fig. 2A). A Foley catheter is inserted on the sterile field. 

患者体位为截石卧位，并根据体型采取水平仰卧或轻度头低脚高位（图2A）。在无菌区插入Foley导尿管。

Fig. 2 (A) Lithotomy position, (B) transrectal ultrasound guidance, (C) incision above the pubis, (D) cystotomy, (E) Alexis wound retractor insertion and (F) Da Vinci access port assembly with insufflation, (G) SP robot docking, (H) partial prostatectomy specimen, and (I) final incision. SP = single port.

图2.（A）截石位，（B）经直肠超声引导，（C）耻骨上方切口，（D）膀胱切开，（E）插入Alexis伤口牵引器，（F）达芬奇单孔port置入与充气，（G）SP机器人定泊，（H）前列腺部分切除标本，和（I）最终切口。SP=单孔。

The Koelis Trinity (Koelis Inc., Princeton, NJ, USA) is used for assistance in localizing a target lesion intraoperatively. Prior to the operation, a radiologist specialized in prostate MRI identifies, digitally tags, and segments suspicious prostate nodules and the urethra. A transrectal ultrasound probe is inserted and fixed into position attached to the operation table. The ultrasound probe rotates automatically, allowing for localization of the tumor intraoperatively in a three-dimensional display (Fig. 2B). 

Koelis Trinity（Koelis Inc., Princeton, NJ, USA）用于协助术中定位目标病变。在手术前，一位专门从事前列腺MRI的放射科医生对可疑的前列腺结节和尿道进行识别、数字标记和划分。插入经直肠超声探头并将其固定在手术台。超声探头自动旋转，可以在术中对肿瘤进行三维定位（图2B）。

The Koelis software is utilized to fuse the preoperative digitally tagged MRI and real-time intraoperative ultrasound images to identify the target lesion in real time, allowing for intraoperative guidance and confirmation of complete excision of the targeted prostatic nodule (Fig. 3). 

利用Koelis软件，对术前数字标记的MRI和术中实时超声图像进行融合，实时识别目标病变，从而进行术中引导并确认完全切除目标前列腺结节（图3）。

Fig. 3 Examples of intraoperative guidance using preoperative MRI-fusion images and pre- and postoperative MRI. (A) The target lesion (shown here in red) and the urethra (shown in yellow) are segmented from the preoperative prostate MRI. Real-time transrectal ultrasound images are shown here (B) before and (C) after resection. (D) Preoperative prostate MRI compared with (E) postoperative MRI showing resection of the entire left lateral lobe of the prostate. MRI = magnetic resonance imaging.

图3. 使用术前MRI融合图像进行术中引导，以及术前和术后MRI。（A）利用术前前列腺MRI区分目标病变（以红色显示）和尿道（以黄色显示）。（B）切除前和（C）切除后的实时经直肠超声图像。比较（D）术前前列腺MRI与（E）术后MRI，显示前列腺整个左侧叶被切除。MRI = 磁共振成像。

Incision and dissection

切开和分离 

A 3 cm vertical incision is made about one to two finger breadths above the pubic symphysis in the midline (Fig. 2C). The anterior rectus fascia is identified and scored with cautery. The rectus muscles are split in the midline and the transversalis fascia is incised. 

在耻骨联合上方1-2横指处于中线作一长为3 cm的纵行切口（图2C）。识别腹直肌前鞘，并用电灼器切开。在中线分开腹直肌，切开腹横筋膜。

Cystotomy

膀胱切开 

The bladder is filled via the Foley catheter with sterile irrigation. A 2 cm vertical midline cystotomy is created, and stay sutures are placed at the apices of the cystotomy. All stay sutures utilized 2-0 Vicryl (Ethicon Inc., Cincinnati, OH, USA; Fig. 2D). 

经Foley导尿管向膀胱内注入生理盐水，使膀胱充盈。于中线纵行切开膀胱，切口长2 cm，并用缝线将膀胱壁切缘与皮肤固定。所有缝线均采用2-0 Vicryl（Ethicon Inc.，Cincinnati, OH, USA；图2D）。

Docking and insufflation

定泊和充气

A wound retractor is placed into the bladder (Fig. 2E). The daVinci SP access port for small incisions (2.7–4 cm) is then attached to the wound retractor (Fig. 2F). An 8 mm AirSeal port is inserted through the access port with initial insufflation pressure of 10–12 mmHg. The SP robot is side docked on the patient's left side, with the bedside assistant on the patient's right (may be reversed based on the room setup; Fig. 2G). 

将伤口牵引器放入膀胱内（图2E）。然后将用于小切口（2.7-4 cm）的达芬奇单孔Port连接到伤口牵引器上（图2F）。通过单孔Port插入一个8 mm的AirSeal Port，初始气腹压为10-12 mmHg。SP机器人侧身停放在患者左侧，床边助手在患者右侧（根据房间的设置可以反过来；图2G）。

In the SP cannula partitioned into four channels, the camera is inserted at the 12:00, monopolar scissors at the 3:00, Maryland bipolar at the 6:00, and Cadier forceps at the 9:00 o'clock position. The robotic scissors are exchanged for a robotic needle holder at the time of intravesical suturing. The robot is angled toward the pelvis (Fig. 2G). 

在划分为四个通道的单孔套管中，在12点位置插入摄像头，在3点位置插入单极剪刀，在6点位置插入马里兰双极钳，在9点位置插入Cadier钳。在膀胱内缝合时，将机器人剪刀换成机器人持针器。机器人的角度朝向盆腔（图2G）。

A remotely operated suction and irrigation system (Vascular Technology, Nashua, NH, USA) is grasped and controlled by the robot console surgeon, and is introduced through the 10 mm channel located at the top of the access port. 

机器人控制台的外科医生远程操作抽吸和冲洗系统（Vascular Technology, Nashua, NH, USA），通过位于单孔Port顶部的10 mm通道置入。

Bladder neck incision

切开膀胱颈

The bladder trigone, bilateral ureteral orifices, and anatomy of the prostatic base or median lobe are visualized. Depending on the location of the tumor, the mucosa is incised distal to the trigone, following the contour of the prostate. Care is taken to avoid injury to the ureteral orifices (Fig. 4A). 

识别膀胱三角区、双侧输尿管口、以及前列腺底部或中叶。根据肿瘤的位置，沿着前列腺的轮廓，在膀胱三角区的远端切开黏膜。注意避免损伤输尿管口（图4A）。

Fig. 4 Intraoperative steps including (A) bladder neck incision, (B) seminal vesicle dissection, (C) left hemigland excision, (D) margin assessment, (E) bladder neck reconstruction, and (F) final catheter insertion.

图4. 术中步骤，包括（A）切开膀胱颈，（B）分离精囊，（C）切除前列腺左侧叶，（D）切缘评估，（E）膀胱颈重建，以及（F）最后插入导尿管。

Posterior dissection

后方分离 

For anteriorly located prostate tumors, dissection of posterior structures and neurovascular bundles may not be necessary. For peripheral zone tumors, dissection of both the anterior and the posterior bladder neck on the ipsilateral side of the target lesion is necessary. The connective tissue attachments posterior to the bladder neck are incised to reveal the vas and the seminal vesicle (SV) on the side of the lesion. The vas deferens is retracted upward (anteriorly) and the vas is transected near the tip of the SV. Robotic applied 5 mm Hem-o-Lok clips (Weck; Teleflex, Wayne, PA, USA) are used to clip the artery at the tip of the SV (Fig. 4B). 

如果前列腺肿瘤位于前部，可能不需要对后部结构和神经血管束进行分离。对于前列腺肿瘤位于外周带，有必要对目标病变同侧的膀胱颈前后方组织进行分离。切开膀胱颈后的结缔组织，以显露病变一侧的输精管和精囊（SV）。向上缩回输精管（前方），在精囊顶端附近横切输精管。用5mm Hem-o-Lok夹（Weck; Teleflex, Wayne, PA, USA）来夹住SV顶端的动脉（图4B）。

Anterior dissection

前方分离

Depending on the laterality of dissection, the bladder neck is incised at the 10:00 (left) or 2:00 (right) o'clock position. For anterior lesions, bilateral anterior dissection is performed. The endopelvic fascia is incised, followed by the puboprostatic ligaments to reveal the dorsal venous complex, which may be either completely ligated or partially ligated using a monofilament barbed suture (3-0 V-loc; Covidien, Mansfield, MA, USA). Apical dissection is performed to reveal the urethra that is divided sharply, preserving as much urethral length as possible. 

在10点（左）或2点（右）位置切开膀胱颈。对于前部病变，进行双侧前方分离。打开盆内筋膜，然后切断耻骨前列腺韧带，显露背侧静脉复合体，可使用单丝倒刺缝线（3-0 V-loc；Covidien, Mansfield, MA, USA）完全结扎或部分结扎。分离前列腺尖部，以显露尿道，锐性切开尿道，尽可能地保留尿道长度。

Pedicle ligation and nerve sparing 

血管蒂结扎和神经保留

While vascular pedicle dissection is not necessary for anterior gland excision, it is important for lateral gland excision. After the anterior and posterior extraprostatic dissections have been started, the intervening posterolateral tissue contains the neurovascular bundles and the vascular pedicle to the prostate. Cautery is minimized by using clips and/or judicious bipolar electrocautery to control the vascular pedicle prior to dividing. 

虽然分离血管蒂对于切除前列腺前部病变没有必要，但对于切除前列腺侧方病变却很重要。分离前列腺外的前方和后方组织后，中间的后外侧组织含有神经血管束和前列腺血管蒂。通过使用钛夹和/或双极电灼来控制血管蒂，可以最大限度地减少灼烧。

Partial gland excision

前列腺部分切除

For anterior prostate gland excision, prostate tissue anterior to the urethra is incised. For lateral gland excision, the prostate is incised in the midline along the urethra (Fig. 4C). This preserves the mucosal strip of the urethra and aids in mucosal approximation during the vesicourethral anastomosis. Once the specimen is free of all attachments, it is removed into the bladder or into the access port (Fig. 2H). Hemostasis may be obtained on the raw surface of the remaining prostate with either directed electrocautery or suture ligation. 

对于前列腺前部病变，要切除尿道前面的前列腺组织。对于前列腺侧方病变，沿尿道于中线切开前列腺（图4C）。这样可以保留尿道的黏膜，有助于在膀胱尿道吻合术中接近黏膜。一旦切下标本，就可以将其移入膀胱或单孔Port（图2H）。可以用电灼或缝合结扎的方式对剩余的前列腺腺体表面进行止血。

After excision of the specimen, ultrasound can assess disappearance of the prostatic nodule preoperative location (Fig. 3C). 

切除标本后，可以利用超声评估前列腺结节术前位置的消失情况（图3C）。

Prostatic excision margin assessment

前列腺切缘评估 

Margins status is assessed by using robotic scissors to remove thin samples of tissue from the apex, mid, and base at the medial and lateral aspects of the excised prostatic surgical area. Biopsies are sent for intraoperative frozen section, and results are obtained prior to the completion of the urethrovesical anastomosis (Fig. 4D). 

通过使用机器人剪刀从前列腺切除区域内侧和外侧的顶点、中间和底部取出较薄的组织样本来评估切缘状态。进行术中冷冻切片活检，获得结果后再完成膀胱尿道吻合（图4D）。

Vesicourethral anastomosis

膀胱尿道吻合

A 3-0 monofilament barbed suture is used to perform the vesicourethral anastomosis from the incised portion of the bladder neck to the urethral stump (Fig. 4E). The pnuemovesicum insufflation pressure is reduced to 7–5 mmHg during this step to facilitate a tension-free anastomosis. Once complete, a new 20 French Foley catheter is inserted and 10–15 ml of sterile water is inserted into the retaining balloon (Fig. 4F). 

使用3-0单丝倒刺缝线从膀胱颈的切口部分到尿道残端进行膀胱尿道吻合（图4E）。期间膀胱内气压降低到7-5 mmHg，以促进无张力吻合。完成吻合后，插入一个新的20 F Foley导尿管，气囊内注入10-15 ml生理盐水水（图4F）。

Bladder, fascia, and skin closure

膀胱、筋膜和皮肤切口闭合

All robotic instruments are removed, the robot is undocked, and the specimen is extracted. The access port is removed. Using an open approach, the cystotomy is closed in two layers—mucosal and detrusor muscle in a running fashion using 2-0 absorbable sutures. The fascia is closed with running 0 Vicryl or PDS sutures, and the skin is reapproximated with 4-0 absorbable sutures and covered with skin glue (Fig. 2I). 

移除所有的机器人器械，机器人撤机，并取出标本。移除单孔Port。采用开放式方法，用2-0可吸收缝线分两层分别闭合膀胱黏膜和逼尿肌，缝合方式为连续缝合。用0号Vicryl缝线或PDS缝线连续缝合筋膜，用4-0可吸收缝线缝合皮肤，并覆以皮肤粘合胶（图2I）。

Postoperative follow-up

术后随访

Patients are discharged with a Foley catheter after a short stay in the recovery room. The Foley catheter is removed, and a trial of void occurs on postoperative day 3. Prostate-specific antigen (PSA) was assessed at 6 wk and then every 3 mo for 1 yr, along with assessments of voiding and erectile function at each visit. Multiparametric prostate MRI is performed at 1 yr followed by a transperineal prostate biopsy (Fig. 3E). 

患者在恢复室短暂停留后出院，体内留置Foley导尿管。术后第3天移除Foley导尿管，尝试排尿。在6周时评估前列腺特异性抗原（PSA），然后每3个月评估一次，为期1年，同时在每次随访时评估排尿和勃起功能。1年时进行多参数前列腺MRI检查，然后进行经尿道前列腺活检（图3E）。

Results

结果

The median operative time and estimated blood loss were 208 min and 50 ml, respectively (Table 1). Blood transfusion was not needed in any patient. No intraoperative complications were noted. There was no need for additional ports or drains. No patients required an inpatient stay, with a median length of stay of 3.8 h. There were no readmissions. Pain scores at discharge were low with a median of 3/10, and one patient with a history of chronic pain medication use required an opioid prescription at discharge. Foley catheters remained in place for 3 d, and all patients were able to void initially, though two patients required Foley catheter reinsertion temporarily for 24 h and 72 h for hypercontinence after which they were able to void normally. 

中位手术时间为208分钟，中位失血量50 ml（表1）。没有患者需要输血。没有发生术中并发症。没有患者需要置入额外操作孔或引流。没有患者需要住院，均为门诊日间手术，中位住院时长为3.8小时，没有再入院的情况。患者出院时的疼痛评分很低，中位数为3/10，一例有慢性疼痛药物使用史的患者离开时需要阿片类药物。Foley导尿管留置3天，所有患者最初均能正常排尿，但有两例患者因尿失禁分别需要临时重新置入Foley导尿管24小时和72小时，之后能够正常排尿。

Three patients had pathology upgrading, and the remaining six patients showed concordance with their prostate biopsy and surgical pathology. All patients had negative margins of frozen sections and final pathology obtained intraoperatively from the resection bed; however, the final report on the partial prostatectomy specimens revealed focally positive margins in four patients.

3例患者病理升级，其余6例患者的前列腺活检结果和手术病理结果一致。所有患者的冰冻切片和术中切除区域标本的最终病理结果都是切缘阴性；然而，前列腺部分切除术标本的最终报告显示有4例患者为切缘局灶阳性。

Table 1 Perioperative outcomes, pathology, and functional outcomes. EBL = estimated blood loss; IQR = interquartile range; PSA = prostate-specific antigen; SHIM = Sexual Health Inventory for Men.

表1.围手术期结局、病理结果和功能性结局。EBL=估计失血量；IQR=四分位数范围；PSA=前列腺特异性抗原；SHIM=男性性健康量表。

Discussion

讨论

In this study, we present our technique and initial outcomes of SP transvesical partial prostatectomy. To our knowledge, this is the first clinical report of this technique using the da Vinci SP surgical platform and a transvesical approach, which was previously shown to be technically feasible in a cadaver model [2]. The technique described here was developed based on experience with the SP transvesical radical prostatectomy and SP transvesical simple prostatectomy, both of which utilize a similar transvesical approach, positioning, and equipment.

本研究介绍了单孔经膀胱前列腺部分切除术的技术和初步结局。据我们所知，这是第一项使用达芬奇单孔手术系统并经膀胱进行前列腺切除的临床报告，之前有研究是在尸体模型中显示机器人单孔经膀胱前列腺部分切除术在技术上是可行的[2]。本文描述的技术是根据单孔经膀胱根治性前列腺切除术和单孔经膀胱单纯前列腺切除术的经验开发的，这两种手术都采用类似的经膀胱入路、定位和设备。

Benefits of this procedure shown here include limited perioperative pain, short recovery period with same-day discharge, and a similar catheter duration to that of focal ablation. Intraoperative navigation using fused MRI and transrectal ultrasound imaging allows for precise localization of prostate anatomy. Our cohort results are encouraging in terms of low morbidity, and maintenance of functional outcomes. Long-term follow-up will clarify the oncologic control of this approach and define the role of this minimally invasive approach as a focal treatment option.

单孔经膀胱前列腺部分切除术的优点包括围手术期疼痛有限、恢复期短、手术当天即可出院、导尿管留置时间与局灶消融术相似。在术中使用融合MRI和经直肠超声成像，可以对前列腺解剖结构进行精确定位。患者队列结果良好，包括不良事件发生率较低、功能性结局良好。长期随访将阐明单孔经膀胱前列腺部分切除术的肿瘤控制情况，并确定这种微创方法作为局灶治疗的作用。

Limitations of this study include its retrospective nature, small sample size, and lack of a control group. Nonetheless, the primary goal of this study is to report our technique and initial experience with short-term follow-up. Given the novelty of this technique, SP transvesical partial prostatectomy at our institution is offered only to carefully selected patients who are counseled thoroughly. Current data collection efforts and future studies will aim to evaluate functional and oncologic outcomes, as well as compare outcomes with other focal and whole-gland therapies.

本研究的局限性包括研究是回顾性研究、样本量小以及缺乏对照组。但是，本研究的主要目的是报告单孔经膀胱前列腺部分切除术的技术和初步经验（短期随访）。鉴于这种技术的新颖性，在我们的机构中，只对经过仔细筛选并提供了全面咨询的患者进行。目前的数据收集工作和未来的研究将旨在评估功能性和肿瘤学结局，以及与其他局灶治疗和全腺体治疗的结局进行比较。

Conclusions

结论

This study suggests that a partial prostatectomy using a novel SP robotic transvesical approach is safe and feasible in carefully selected patients with localized low- and intermediate-risk prostate cancer. This technique provides advantages of Retzius sparing and accessing prostate nodules selectively in various prostate locations. Although early perioperative and functional outcomes are impressive, future studies of this patient population will be focused on long-term oncologic outcomes.

本研究表明，对于经过仔细筛选的低危和中危局限性前列腺癌患者，进行机器人单孔经膀胱前列腺部分切除术是安全可行的。该技术的优势包括可保留耻骨后间隙以及选择性接近前列腺不同位置结节。初步的围手术期和功能结局令人印象深刻，未来将集中研究该患者群体的长期肿瘤学结局。