前列腺癌在男性人群中发病率较高，根治性手术是局限性前列腺癌治疗的主要手段。随着机器人手 术技术的发展，机器人辅助前列腺癌根治术在减少术中出血、降低手术并发症发生率及改善术后生活质量等方面展 现出了一定的优势。借助于机器人手术系统高度灵活的器械和 3D 高清视野，单孔机器人在前列腺癌根治术中的应 用不断深入。单孔机器人辅助下前列腺癌根治术的手术入路主要有 4 种，分别为经腹腔入路、腹膜外入路、经膀胱 入路和经会阴入路。本文就不同入路单孔机器人辅助下根治性前列腺切除术的效果进行综述。

Prostate cancer is very common in men, and radical prostatectomy is the primary treatment for locally advanced prostate cancer. Robot-assisted radical prostatectomy has advantages of lower blood loss, fewer complications, and better quality of life after surgery. Due to high flexibility and magnified 3D vision of robotic surgical system, single-port robotassisted radical prostatectomy is increasingly used in recent years. There are mainly four surgical approaches for single-port robot-assisted radical prostatectomy: transperitoneal, extraperitoneal, transapical and perineal approach. The current status of single-port robot-assisted laparoscopic radical prostatectomy under different approaches was reviewed in this paper.

收稿日期：2022-04-26  录用日期：2022-06-27 

Received Date: 2022-04-26  Accepted Date: 2022-06-27

基金项目：浙江省自然科学基金项目（LQ19H050011）

Foundation Item: Natural Science Foundation of Zhejiang Province (LQ19H050011)

通讯作者：陈栋园，Email：c.dy@zju.edu.cn 

Corresponding Author: CHEN Dongyuan, Email: c.dy@zju.edu.cn 

引用格式：章桦莉，朱世斌，陈栋园 . 不同入路单孔机器人辅助下根治性前列腺切除术的应用现状 [J]. 机器人外科学杂志（中英文）， 2022，3（6）：442-450.

Citation: ZHANG H L, ZHU S B, CHEN D Y. Current status of single-port robot-assisted laparoscopic radical prostatectomy under different approaches[J]. Chinese Journal of Robotic Surgery, 2022, 3(6): 442-450.

[1] Fitzmaurice C, Allen C, Barber R M, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disabilityadjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2017, 3(4): 524-548.

[2] Desai M M, Aron M, Berger A, et al. Transvesical robotic radical prostatectomy[J]. BJU Int, 2008, 102(11): 1666-1669. 

[3] Kaouk J H, Goel R K, Haber G P, et al. Robotic singleport transumbilical surgery in humans: initial report[J]. BJU Int, 2009, 103(3): 366-369.

[4] Autorino R, Kaouk J H, Stolzenburg J U, et al. Current status and future directions of robotic single-site surgery: a systematic review[J]. Eur Urol, 2013, 63(2): 266-280. 

[5] Bertolo R, Garisto J, Gettman M, et al. Novel system for robotic single-port surgery: feasibility and state of the art in urology[J]. Eur Urol Focus, 2018, 4(5): 669-673.

[6] Kaouk J H, Haber G P, Autorino R, et al. A novel robotic system for single-port urologic surgery: first clinical investigation[J]. Eur Urol, 2014, 66(6): 1033-1043.

[7] Frazier H A, Robertson J E, Paulson D F. Radical prostatectomy: the pros and cons of the perineal versus retropubic approach[J]. J Urol, 1992. DOI: 10.1016/ s0022-5347(17)37413-x.

[8] Laydner H, Akca O, Autorino R, et al. Perineal robotassisted laparoscopic radical prostatectomy: feasibility study in the cadaver model[J]. J Endourol, 2014, 28(12): 1479-1486. [9] Simorov A, Otte R S, Kopietz C M, et al. Review of surgical robotics user interface: what is the best way to control robotic surgery?[J] Surg Endosc, 2012, 26(8): 2117-2125. 

[10] Peters B S, Armijo P R, Krause C, et al. Review of emerging surgical robotic technology[J]. Surg Endosc, 2018, 32(4): 1636-1655. 

[11] Ramirez D, Maurice M J, Kaouk J H. Robotic perineal radical prostatectomy and pelvic lymph node dissection using a purpose-built single-port robotic platform[J]. BJU Int, 2016, 118(5): 829-833.

[12] CHANG Y, XU W, LU X, et al. Robotic perineal radical prostatectomy: initial experience with the da Vinci Si robotic system[J]. Urol Int, 2020, 104(9-10): 710-715. 

[13] Kaouk J, Garisto J, Bertolo R. Different approaches to the prostate: the upcoming role of a purpose-built single-port robotic system[J]. Arab J Urol, 2018, 16(3): 302-306. 

[14] Kaouk J, Aminsharifi A, Wilson C A, et al. Extraperitoneal versus transperitoneal single port robotic radical prostatectomy: a comparative analysis of perioperative outcomes[J]. J Urol, 2020, 203(6): 1135-1140.

[15] Agarwal D K, Sharma V, Toussi A, et al. Initial experience with da vinci single-port robot-assisted radical prostatectomies[J]. Eur Urol, 2020, 77(3): 373-379. 

[16] Abaza R, Martinez O, Murphy C, et al. Adoption of single-port robotic prostatectomy: two alternative strategies[J]. J Endourol, 2020, 34(12): 1230-1234. 

[17] Jones R, Dobbs R W, Halgrimson W R, et al. Single port robotic radical prostatectomy with the da Vinci SP platform: a step by step approach[J]. Can J Urol, 2020, 27(3): 10263-10269. 

[18] Ng C F, Teoh J Y, Chiu P K, et al. Robot-assisted single-port radical prostatectomy: a phase 1 clinical study[J]. Int J Urol, 2019, 26(9): 878-883. 

[19] Saidian A, Fang A M, Hakim O, et al. Perioperative outcomes of single vs multi-port robotic assisted radical prostatectomy: a single institutional experience[J]. J Urol, 2020, 204(3): 490-495. 

[20] Vigneswaran H T, Schwarzman L S, Francavilla S, et al. A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy[J]. Eur Urol, 2020, 77(6): 671-674.

[21] CHANG Y, LU X, ZHU Q, et al. Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): initial experience[J]. Asian J Urol, 2019, 6(3): 294-297. 

[22] Kim K H, Song W, Yoon H, et al. Single-port robotassisted radical prostatectomy with the da Vinci SP system: a single surgeon’s experience[J]. Investig Clin Urol, 2020, 61(2): 173-179. [23] Thompson J E, Egger S, Böhm M, et al. Superior biochemical recurrence and long-term quality-oflife outcomes are achievable with robotic radical prostatectomy after a long learning curve-updated analysis of a prospective single-surgeon cohort of 2206 consecutive cases[J]. Eur Urol, 2018, 73(5): 664-671.

[24] White M A, Haber G P, Autorino R, et al. Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes[J]. Eur Urol, 2010, 58(4): 544-550.

[25] Garbens A, Morgan T, Cadeddu J A. Single Port Robotic Surgery in Urology[J]. Curr Urol Rep, 2021, 22(4): 1-8. 

[26] Trabulsi E J, Guillonneau B. Laparoscopic radical prostatectomy[J]. J Urol, 2005, 173(4): 1072-1079. 

[27] Aminsharifi A, Sawczyn G, Wilson C A, et al. Technical advancements in robotic prostatectomy: single-port extraperitoneal robotic-assisted radical prostatectomy and single-port transperineal robotic-assisted radical prostatectomy[J]. Transl Androl Urol, 2020, 9(2): 848-855. 

[28] Kaouk J, Bertolo R, Eltemamy M, et al. Single-port robot-assisted radical prostatectomy: first clinical experience using the SP surgical system[J]. Urology, 2019. DOI: 10. 1016/j. urology. 2018. 10. 025. 

[29] Lo I S, Lee H Y, Chou Y H, et al. Robot-assisted extraperitoneal radical prostatectomy, single site plus two model[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(2): 140-144.

[30] Li C C, Chien T M, Lee M R, et al. Extraperitoneal robotic laparo-endoscopic single-site plus 1-port radical prostatectomy using the da Vinci single-site platform[J]. J Clin Med, 2021, 10(8): 1563. 

[31] Kaouk J, Valero R, Sawczyn G, et al. Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique[J]. BJU Int, 2020, 125(1): 182-189. 

[32] Wilson C A, Aminsharifi A, Sawczyn G, et al. Outpatient extraperitoneal single-port robotic radical prostatectomy[J]. Urology, 2020. DOI: 10.1016/ j.urology.2020.06.029.

[33] Aminsharifi A, Wilson C A, Sawczyn G, et al. Predictors associated with a prolonged hospital stay after singleport extraperitoneal robotic radical prostatectomy: a comparative analysis of outpatient versus inpatient care[J]. J Endourol, 2020, 34(10): 1049-1054. 

[34] Moro F D, Beltrami P, Zattoni F. Can anastomotic urinary leakage in robotic prostatectomy be considered as a marker of surgical skill?[J]. Cent European J Urol, 2018, 71(1): 21-25.

[35] CHANG Y F, GU D, MEI N, et al. Initial experience on extraperitoneal single-port robotic-assisted radical prostatectomy[J]. Chin Med J(Engl), 2020, 134(2): 231-233.

[36] Walsh P C, Donker P J. Impotence following radical prostatectomy: insight into etiology and prevention[J]. J Urol, 1982, 128(3): 492-497. 

[37] Kaouk J, Beksac A T, Abou Zeinab M, et al. Single port transvesical robotic radical prostatectomy: initial clinical experience and description of technique[J]. Urology, 2021. DOI: 10.1016/j.urology.2021.05.022.

[38] Chavali J S, Garisto J, Bertolo R, et al. Surgical hints for robot-assisted transvesical simple prostatectomy[J]. Urology, 2018. DOI: 10.1016/j.urology.2018.09.006.

[39] DENG W, JIANG H, LIU X, et al. Transvesical retzius-sparing versus standard robot-assisted radical prostatectomy: a retrospective propensity scoreadjusted analysis[J]. Front Oncol, 2021. DOI: 10.3389/ fonc.2021.687010.

[40] ZHOU X, FU B, ZHANG C, et al. Transvesical robotassisted radical prostatectomy: initial experience and surgical outcomes[J]. Bju International, 2020, 126(2): 300. 

[41] Minafra P, Carbonara U, Vitarelli A, et al. Robotic radical perineal prostatectomy: tradition and evolution in the robotic era[J]. Curr Opin Urol, 2021, 31(1): 11-17. 

[42] Maurice M J, Kaouk J H. Single-port robot-assisted perineal prostatectomy and pelvic lymphadenectomy: step-by-step technique in a cadaveric model[J]. J Endourol, 2018, 32(S1): S93-S96.

[43] Resnick M I. Radical perineal prostatectomy[J]. BJU Int, 2003, 92(6): 522-523. 

[44] Harris MJ. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management[J]. Euro Urol, 2003, 44(3): 303-308.

[45] Lenfant L, Garisto J, Sawczyn G, et al. Robot-assisted radical prostatectomy using single-port perineal approach: technique and single-surgeon matchedpaired comparative outcomes[J]. Euro Urol, 2021, 79(3): 384-392.

[46] Tugcu V, Eksi M, Sahin S, et al. Robot-assisted radical perineal prostatectomy: a review of 95 cases[J]. BJU Int, 2020, 125(4): 573-578. 

[47] Kaouk J H, Akca O, Zargar H, et al. Descriptive technique and initial results for robotic radical perineal prostatectomy[J]. Urology, 2016. DOI: 10. 1016/j. urology. 2016. 02. 063.

[48] Saito S, Murakami G. Radical perineal prostatectomy: a novel approach for lymphadenectomy from perineal incision[J]. J Urol, 2003. DOI: 10.1097/01. ju.0000084329.75188.e6. 

[49] Salomon L, Anastasiadis A G, Levrel O, et al. Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organconfined prostate cancer[J]. Urology, 2003, 61(2): 386-390.

[50] Weldon V E, Tavel F R, Neuwirth H, et al. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy[J]. J Urol, 1995, 153(5): 1565-1569. 

[51] Savera A T, Kaul S, Badani K, et al. Robotic radical prostatectomy with the “Veil of Aphrodite” technique: histologic evidence of enhanced nerve sparing[J]. Eur Urol, 2006, 49(6): 1065-1073. 

[52] Takenaka A, Tewari A K, Leung R A, et al. Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy: anatomic basis and preliminary outcomes[J]. Eur Urol, 2007, 51(2): 433-440.