随着达芬奇机器人手术系统的普及，机器人辅助腹腔镜根治性前列腺切除术逐渐成为早期前列腺癌 患者的首选术式，泌尿外科医生根据临床需要，改良出了多种方法和技术。本团队在不断实践过程中，针对早期局 限性前列腺癌探索出耻骨上四孔法腹膜外入路机器人辅助腹腔镜前列腺癌根治术式。本文将总结归纳该术式的特点， 并分享本团队工作中积累的经验和体会。

With the increasing popularity of Da Vinci robotic surgical system, robot-assisted radical prostatectomy (RARP) becomes the preferred method for early-stage prostate cancer. The urologists have developed different surgical procedures and techniques according to the demand of clinical practice. Our team created a new surgical procedure called extraperitoneal fourport robot-assisted radical prostatectomy. In this study, the characteristics and experiences of this new surgical procedure were summarized.

收稿日期：2023-01-07  录用日期：2023-03-09 

Received Date: 2023-01-07  Accepted Date: 2023-03-09 

基金项目：浙江省医药卫生科技计划项目（2024KY094） 

Foundation Item: Medical and Health Technology Plan Project of Zhejiang Province (2024KY094) 

通讯作者：经霄，Email：0095460@zju.edu.cn 

Corresponding Author: JING Xiao, Email: 0095460@zju.edu.cn 

引用格式：李忠义，徐聪聪，张益曼，等 . 四孔法腹膜外入路机器人辅助根治性前列腺切除术经验分享（附手术视频）[J]. 机器人 外科学杂志（中英文），2024，5（6）：1013-1017. 

Citation: LI Z Y, XU C C, ZHANG Y M, et al. Experience with extraperitoneal four-port robot-assisted radical prostatectomy (with surgical video)[J]. Chinese Journal of Robotic Surgery, 2024, 5(6): 1013-1017.

[1] Schaeffer E M, Srinivas S, Adra N, et al. Nccn guidelines(r) insights: prostate cancer, version 3.2024 [J]. J Natl Compr Canc Netw, 2024, 22(3): 140-150. 

[2] Cornford P, van den Bergh R C N, Briers E, et al. Eau-eanm-estroesur-isup-siog guidelines on prostate cancer-2024 update. Part I: Screening, diagnosis, and local treatment with curative intent [J]. Eur Urol, 2024, 86(2): 148-163. 

[3] Petrelli F, Dottorini L, De Stefani A, et al. Localized prostate cancer in older patients: radical prostatectomy or radiotherapy versus observation [J]. J Geriatr Oncol, 2024, 15(6): 101792. 

[4] HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022 [J]. J Natl Cancer Cent, 2024, 4(1): 47-53. 

[5] Gandaglia G, Montorsi F, Karakiewicz P I, et al. Robot-assisted radical prostatectomy in prostate cancer [J]. Future Oncol, 2015, 11(20): 2767-2773. 

[6] Mistretta F A, Grasso A A, Buffi N, et al. Robot-assisted radical prostatectomy: recent advances [J]. Minerva Urol Nefrol, 2015, 67(3): 281-292. 

[7] Carbonara U, Srinath M, Crocerossa F, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes [J]. World J Urol, 2021, 39(10): 3721-3732. 

[8] DU J P, WANG X H, SHAN L Q, et al. Safety and efficacy of minimally invasive transforaminal lumbar interbody fusion combined with gelatin sponge impregnated with dexamethasone and no drainage tube after surgery in the treatment of lumbar degenerative disease [J]. Orthop Surg, 2021, 13(3): 1077-1085. 

[9] Kang H, Chung Y S, Choe J W, et al. Application of lidocaine jelly on chest tubes to reduce pain caused by drainage catheter after coronary artery bypass surgery [J]. J Korean Med Sci, 2014, 29(10): 1398-1403. 

[10] Huynh L M, Ahlering T E. Robot-assisted radical prostatectomy: a step-by-step guide [J]. J Endourol, 2018, 32(S1): S28-S32. 

[11] Porpiglia F, De Luca S, Bertolo R, et al. Robot-assisted extended pelvic lymph nodes dissection for prostate cancer: personal surgical technique and outcomes [J]. Int Braz J Urol, 2015, 41(6): 1209-1219. 

[12] Uy M, Cassim R, Kim J, et al. Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis [J]. J Robot Surg, 2022, 16(2): 257-264. 

[13] Semerjian A, Pavlovich C P. Extraperitoneal robot-assisted radical prostatectomy: indications, technique and outcomes [J]. Curr Urol Rep, 2017, 18(6): 42. 

[14] Khalil M I, Joseph J V. Extraperitoneal single-port robot-assisted radical prostatectomy [J]. J Endourol, 2021, 35(S2): S100-S105. 

[15]   Fahmy O, Fahmy U A, Alhakamy N A, et al. Single-port versus multiple-port robot-assisted radical prostatectmy: a systematic review and Meta-analysis [J]. J Clin Med, 2021, 10(24): 5723. 

[16] Abou Zeinab M, Beksac A T, Ferguson E, et al. Single-port extraperitoneal and transperitoneal radical prostatectomy: a multiinstitutional propensity-score matched study [J]. Urology, 2023. DOI: 10.1016/j.urology.2022.10.001. 

[17] Chang C H, Lee H K, Nam S H. The displacement of the tracheal tube during robot-assisted radical prostatectomy [J]. Eur J Anaesthesiol, 2010, 27(5): 478-480. 

[18] Awad H, Santilli S, Ohr M, et al. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy [J]. Anesth Analg, 2009, 109(2): 473-478. 

[19] Sujata N, Tobin R, Mehta P, et al. Optic nerve sheath diameterguided extubation plan in obese patients undergoing robotic pelvic surgery in steep trendelenburg position: a report of three cases [J]. Indian J Anaesth, 2018, 62(11): 896-899. 

[20] Arvizo C, Mehta S T, Yunker A. Adverse events related to trendelenburg position during laparoscopic surgery: recommendations and review of the literature [J]. Curr Opin Obstet Gynecol, 2018, 30(4): 272-278. 

[21] Meininger D, Zwissler B, Byhahn C, et al. Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery [J]. World J Surg, 2006, 30(4): 520-526. 

[22] Meininger D, Westphal K, Bremerich D H, et al. Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy [J]. World J Surg, 2008, 32(7): 1400-1405. 

[23] 吕倩 , 卫义 , 王尧谦 , 等 . 改良单切口机器人辅助根治性前列腺 切除术的初步疗效 [J]. 中华泌尿外科杂志 , 2021, 42(11): 830-833. 

[24] 周放 , 任尚青 , 范世达 , 等 . 经腹膜外单切口机器人根治性前列 腺切除术 - 改良通道建立及初步应用观察 [J]. 中华男科学杂志 , 2021, 27(10): 892-898. 

[25] 徐臻 , 李忠义 , 郑嘉文 , 等 . 日间手术模式行经膀胱入路机器人 辅助腹腔镜下根治性前列腺切除术的临床研究 [J]. 机器人外科 学杂志 ( 中英文 ), 2021, 2(4): 287-294.