Application Of Seven Pelvic Fat As Anatomical Landmarks In Extraperitoneal Laparoscopic Radical Prostatectomy

Background and PurposeLaparoscopic technology has been widely used in the field of urology with the continuous improvement of minimally invasive concept and techniques.Compared with traditional open surgery,it has the advantages of smaller wound,lighter pain and quicker postoperative recovery^[1].Correspondingly,laparoscopic technology also plays an important role in the treatment of prostate carcinoma（PCa）.Several methods have been developed in laparoscopic radical prostatectomy（LRP）with different advantages.For the obvious advantages of less effect on abdominal organs,the extraperitoneal approach is widely used as the main treatment for localized PCa^[2]in clinical practise.Extraperitoneal LRP is currently highly challenging for urologists because of the relatively small operating space,rich prostate blood supply,and lack of clear boundaries with adjacent tissues.Based on this,how to accurately distinguish the anatomy of the prostate and its surrounding tissues,further reduce the side injury and postoperative complications,and increase the safety of the operation is always a focus in clinical research.Therefore,we employ the pelvic fat surrounding the prostate as an anatomical landmark of LRP and explore its values in clinical applications in our research.MethodsAccording to the inclusion and exclusion criteria,the clinical data of patients who underwent LRP were retrospectively analyzed from January 2013 to December2019 in the First Affiliated Hospital of Harbin Medical University.All studies were approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University.These patients were divided into control group and experimental group according to whether the opreator used seven pelvic fat as anatomical landmarks in LRP.The perioperative indicators of the two groups were compared,including preoperative baseline data,intraoperative operative time,and blood loss et.Using SPSS 17.0 software for analysis,P<0.05 was considered statistically significant.ResultsIn total,data from 42 patients were analyzed this study,including 17 in the experimental group and 25 in the control group.The difference between the two groups were age（68.24±6.14vs.66.61±6.22,P>0.05）,body mass index（21.23±2.89vs.20.58±3.16,P>0.05）,prostate specific antigen（PSA）（21.53±9.67vs.23.12±11.81,P>0.05）,Gleason score（7.25±1.45vs.7.56±1.36,P>0.05）,there was no significant statistical difference（P>0.05）.Both the experimental group and the control group had significant operating time（167.35±32.60vs.213.40±76.51,P<0.05）and intraoperative blood loss（199.28±41.05vs.247.52±72.33,P<0.05）.According to the postoperative pathological results,there was a significant difference in the positive rate of surgical margins between the two groups（5.9%vs.32.0%,P<0.05）.There was no significant difference in the incidence of rectal injury between the two groups（0%vs.8.0%,P>0.05）.ConclusionsThe use of seven pelvic fats as anatomical landmarks can reduce the time of LRP operation,reduce the amount of bleeding and the positive rate of margins,so they contribute to distinguish the anatomy of the prostate and its surrounding tissues to increase the safety and effectiveness of the operation.