Retzius Sparing: Ρομποτικά υποβοηθούμενη λαπαροσκοπική ριζική προστατεκτομή

Retzius Sparing: Ρομποτικά υποβοηθούμενη λαπαροσκοπική ριζική προστατεκτομή

H μετεξέλιξη της ρομποτικά υποβοηθούμενης χειρουργικής

Η ριζική προστατεκτομή αποτελεί τη θεραπεία εκλογής για την αντιμετώπιση του εντοπισμένου καρκίνου του προστάτη. H ρομποτικά υποβοηθούμενη χειρουργική με το σύστημα DaVinci (Intuitive Surgical Inc, Sunnyvale, CA, H.Π.Α.) έχει βελτιώσει σημαντικά τη χειρουργική τεχνική σε σχέση με την ανοιχτή ή λαπαροσκοπική προσέγγιση. Μια νέα εξέλιξη στα πλαίσια της χειρουργικής μεθόδου με το σύστημα DaVinci, σχετικά με τoν καρκίνο του προστάτη, είναι η λεγόμενη μέθοδος Retzius Sparing. Επιστημονικές μελέτες δείχνουν ότι η τεχνική αυτή οδηγεί σε ακόμη καλύτερα χειρουργικά αποτελέσματα, καθώς διατηρούνται ανέπαφες οι παρακείμενες ανατομικές δομές του προστάτη (αγγεία, περιτονίες, σύνδεσμοι κ.λπ.). Επίσης, οι ασθενείς επανακτούν την εγκράτεια των ούρων καθώς και τη στυτική λειτουργία τους σημαντικά ταχύτερα μετά την επέμβαση, σε αντίθεση με τη συμβατική πρόσθια ρομποτικά υποβοηθούμενη προστατεκτομή (AA-RARP).

Η Τεχνική

Εφαρμόζοντας τη συγκεκριμένη τεχνική αφαιρείται, όπως και στη συμβατική-πρόσθια ρομποτικά υποβοηθούμενη ριζική προστατεκτομή (AA-RARP), ο προστάτης, οι σπερματοδόχες κύστεις, καθώς και οι πυελικοί λεμφαδένες, όταν χρειάζεται. Αυτό επιτυγχάνεται μέσω μιας μικρής οπίσθιας τομής στο περιτόνεο (συνήθως 4 εκατοστά), κατά την οποία αφαιρείται ο προστάτης μετά από απελευθέρωση των σπερματικών πόρων και των σπερματοδόχων κύστεων. Η διαφορά, ωστόσο, είναι ότι η νέα προσέγγιση οδηγεί στη διατήρηση όλων των ανατομικών δομών που βρίσκονται εμπρός στο χώρο του Retzius. (φλεβικό πλέγμα του Santorini, περιπροστατική περιτονία, ηβοπροστατικοί σύνδεσμοι και σε ποσοστό 30% των ανδρών, κλάδος της αιδοιικής αρτηρίας). Σε αντίθεση με την πρόσθια-συμβατική προσέγγιση, αποφεύγεται ο τραυματισμός των ανατομικών δομών, που αναφέρθηκαν, οι οποίες είναι σημαντικές για τη διατήρηση της εγκράτειας των ούρων και της στυτικής λειτουργίας.

Πλεονεκτήματα

Σημαντικό πλεονέκτημα της Retzius Sparing ριζικής προστατεκτομής (RS-RP) είναι ότι επιτρέπει τη γρήγορη αποκατάσταση της εγκράτειας των ούρων μετεγχειρητικά, όπως περιγράφεται στις περισσότερες μελέτες. Η Retzius Sparing ριζική προστατεκτομή υπερέχει της συμβατικής πρόσθιας ρομποτικά υποβοηθούμενης ριζικής προστατεκτομής (ΑΑ-RARP), καθώς ο χρόνος επανόδου της εγκράτειας των ούρων είναι ταχύτερος, ενώ τα ποσοστά των ασθενών με εγκράτεια ούρων είναι υψηλότερα. Η επάνοδος της εγκράτειας των ούρων σε διάστημα 7 ημερών από την αφαίρεση του καθετήρα ανέρχεται σε ποσοστό 91 % των ασθενών εφαρμόζοντας τη Retzius Sparing ριζική προστατεκτομή (RS-RP), σε αντίθεση με τη συμβατική πρόσθια ρομποτικά υποβοηθούμενη ριζική προστατεκτομή (AA-RARP), όπου η εγκράτεια των ουρων φτάνει μόλις το 62,5 % των ασθενών 4 εβδομάδες μετεγχειρητικά.

Επιπλέον, η αρτηριακή αιμάτωση του πέους είναι σημαντική για τη διατήρηση της στύσης μετά από ριζική προστατεκτομή. Με την αναφερόμενη τεχνική διατηρείται ο κλάδος της αιδοιικής αρτηρίας, όταν υπάρχει, καθώς και το φλεβικό πλέγμα του Santorini σε αντίθεση με την πρόσθια-συμβατική προσέγγιση. Αυτό έχει ως αποτέλεσμα η στυτική λειτουργία να αποκαθίσταται σε ποσοστό 76 – 86,5 %  των ασθενών εντός 12 μηνών, όπως περιγράφεται σε μελέτες του Eden και Galfano.

Επιστημονικές μελέτες, τέλος, έδειξαν ότι δεν υπάρχει διαφορά στο ογκολογικό αποτέλεσμα μεταξύ της Retzius Sparing ρομποτικά υποβοηθούμενης ριζικής προστατεκτομής και της πρόσθιας συμβατικής προσέγγισης. Η εξειδικευμένη ομάδα της χειρουργικής ουρολογίας με επικεφαλής Λάμπρο Σαρόπουλο F.E.B.U, Χειρουργό Ουρολόγο, Χρήστο Ροδίου F.E.B.U,Χειρουργό Ουρολόγο με εκπαίδευση σε αναγνωρισμένα κέντρα του εξωτερικού και μεγάλη εμπειρία στη συγκεκριμένη τεχνική, μπορεί να εξασφαλίσει αντίστοιχα με το εξωτερικό αποτελέσματα και στην Ελλάδα.

Λέμε ΝΑΙ στην ποιότητα ζωής,

Λέμε ΟΧΙ στην ακράτεια ουρων!

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