Comparison Of Robotic Assisted Laparoscopic And Laparoscopy In Radical Prostatectomy

BackgroundProstate cancer refers to epithelial malignant tumors originating from the prostate,and its incidence has significant ethnic and regional differences.In developed countries in Europe and the United States,the incidence of prostate cancer is the highest in male malignant tumors,and its mortality is the second leading cause of death in male malignant tumors.The incidence and mortality of prostate cancer in China are lower than those in developed countries in Europe and America.However,the incidence and mortality of prostate cancer in China have shown a rapid growth trend in the past 10 years,and the death/incidence ratio of prostate cancer in China is much higher than that in developed countries.Level prostate cancer can be divided into localized prostate cancer and high-risk prostate cancer.Radical prostatectomy is the most effective treatment for localized prostate cancer and some high-risk prostate cancer.Radical prostatectomy mainly includes three surgical methods:open surgery,laparoscopic radical prostatectomy,robot-assisted laparoscopic radical prostatectomy surgery.With the development of science and technology,surgery is undergoing the development from open surgery to minimally invasive surgery.In 2000,Binder and Kramer performed the first robotic radical prostatectomy for prostate cancer,and the number of surgical procedures continued to increase.The first robotic assisted laparoscopic radical prostatectomy in China was implemented in 2007.Subsequently,the da Vinci robotic surgery system was introduced successively in major hospitals in China,and related research also confirmed its advantages in radical prostatectomy.ObjectiveTo analyze the effect of robot-assisted laparoscopic and laparoscopy in the treatment of prostate cancer with radical prostatectomy,and to explore the clinical value of robot-assisted laparoscopic radical prostatectomy.MethodsA total of 68 patients undergoing radical prostatectomy were enrolled in our hospital from March 2014 to July 2018.Among them,38 patients underwent laparoscopic radical prostatectomy with da Vinci robotic assisted radical surgery and 30 patients underwent laparoscopic radical prostatectomy.The patients were diagnosed with prostate adenocarcinoma before surgery.By analyzing the patient clinical data and follow-up results,the operation time,intraoperative blood loss,perioperative blood transfusion rate,gastrointestinal function recovery time,drainage tube indwelling time,postoperative hospital stay,postoperative urinary control(March,June,December),the total cost of hospitalization,the postoperative follow-up ended in February 2019.The data was statistically analyzed using SPSS 20.0 software.Quantitative data were expressed as(?)±s.The t-test was used between the two groups.Qualitative data were used to give the number and percentage of each category.The analysis was performed by x~2test.The difference was statistically significant at(P<0.05).ResultIn our hospital,da Vinci robot assisted laparoscopic radical prostatectomy in 38 cases,aged from 54 to 81(67.3±7.2)years old.Serum prostate specific antigen(PSA)<10ng/ml 6cases,12 cases of 10～20ng/ml,18 cases of 20～100ng/ml,2 cases of>100ng/ml.Prostate volume 17～124ml,mean(43.9±22.1)ml;3 patients underwent transurethral resection of prostate for pathological report of prostate adenocarcinoma,and the rest under ultrasound-guided transrectal prostate biopsy,pathologically confirmed as prostate adenocarcinoma Gleason scored 6-9 points.Laparoscopic radical prostatectomy was performed in 30 patients,aged 54-76 years,with an average age of(67.3±6.2)years.6 cases of PSA<10ng/ml,8 cases of 10～20ng/ml,15 cases of 20～100ng/ml,1 case of>100ng/ml.The volume of prostate was18-88 ml,with an average of(37.6±18.3)ml.Two patients underwent transurethral resection of the prostate for adenocarcinoma.All patients underwent ultrasound-guided transrectal prostate biopsy.The prostate adenocarcinoma with a Gleason score of 5-9 points.All patients had no pelvic lymph node metastasis and bone metastases before the preoperative examination.There were no significant differences in clinical data between the two groups in terms of age,serum PSA,prostate volume,and Gleason score.The operation was successfully completed in both groups.The robotic assisted prostate cancer radical surgery group was better than the laparoscopic radical prostatectomy group in the postoperative urinary control group.The intraoperative blood loss and perioperative blood transfusion rate were lower than those of the laparoscopic radical prostatectomy group(P<0.05);There was no statistical difference in postoperative hospital stay,gastrointestinal function recovery time,drainage tube indwelling time and postoperative hospital stay.The total hospitalization cost was higher than the laparoscopic radical prostatectomy group.In conclusion,robot-assisted laparoscopic radical prostatectomy with fewer complications and good postoperative urinary control is a safe and effective minimally invasive procedure for the treatment of prostate cancer.