surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2018-8-2-33-40surgonco-316Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESТехнические особенности выполнения роботассистированной простатэктомии у пациентов с выраженным увеличением простаты в объемеTechnical Features of Robot-Assisted Prostatectomy in Patients with Very Enlarged Prostateshttps://orcid.org/0000-0001-8105-7233ЗыряновА. В.ZyryanovA. V.

д.м.н, профессор, проректор по учебной работе, 

620028, Екатеринбург, ул. Репина, 3

Doctor of Medical Sciences, Professor of Urology, Vice-rector for Academic Affairs,

3 Repin str., Yekaterinburg, 620028

zav1965@mail.ruПономаревА. В.PonomarevA. V.

заведующий отделением онкологии,

625000, Тюмень, ул. Юрия Семовских, 8/1

Head of the Department of Oncology,

8/1 Yuriy Semovskikh str., Tyumen, 625000

ponomarevekb@gmail.comСмирновВ. О.SmirnovV. O.

аспирант кафедры онкологии с курсом урологии, 

625023, Тюмень, ул. Одесская, 54

Post-graduate student of the Department of Oncology with the Course of Urology,

54 Odesskaya str., Tyumen, 625023

svo1993@bk.ruhttps://orcid.org/0000-0003-1238-4761СуриковА. С.SurikovA. S.

врач-уролог отделения онкологии,

625000, Тюмень, ул. Юрия Семовских, 8/1

Urologist of the Department of Oncology,

8/1 Yuriy Semovskikh str., Tyumen, 625000

Surikov.a.s@mail.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationОбластной урологический центр АО «Медико-санитарная часть «Нефтяник»РоссияRegional Urological Center of the Medical Care Unit “Neftyanik”Russian FederationТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian Federation20180311201882117124Copyright © Зырянов А.В., Пономарев А.В., Смирнов В.О., Суриков А.С., 20182018Зырянов А.В., Пономарев А.В., Смирнов В.О., Суриков А.С.Zyryanov A.V., Ponomarev A.V., Smirnov V.O., Surikov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/316Введение

Введение. По данным научных исследований аденокарцинома сочетается с аденоматозной тканью в рамках одной предстательной железы в 10–83,3 % случаев (включая инцидентальный рак). Клиническая ситуация, при которой аденома достигает внушительных размеров (обычно более 80 см3 ) и создает значительные трудности для хирурга, встречается не более чем в 8–10 % всех случаев простатэктомий. Учитывая ограничения дистанционной лучевой терапии, а также брахитерапии, связанные с объемом простаты и неудовлетворительным качеством мочеиспускания, радикальная простатэктомия у данной группы пациентов остается лечением выбора. Особенности аденомы, такие как большие срединные и боковые доли, наличие цистостомы, а также камней мочевого пузыря, существенно затрудняют выполнение оперативного пособия. Когда крупный объем простаты является одной из исходных перед оперативным вмешательством, роботическая технология может иметь определенные преимущества.

Основной целью данной работы является демонстрация технических преимуществ робот-ассистированной простатэктомии, связанных с увеличением простаты.

Результаты и обсуждение

Результаты и обсуждение. Мы попытались описать анатомические ориентиры и возможные хирургические методы преодоления различных вариаций доброкачественной гиперплазии простаты при робот-ассистированной простатэктомии. Данная информация особенно полезна хирургам, осваивающим роботическую платформу. Робот-ассистированная простатэктомия может быть эффективно использована при лечении рака предстательной железы, сопряженного с доброкачественной гиперплазией простаты, а пациенты могут быть уверены в хороших результатах операции.

Заключение

Заключение. При наличии достаточного опыта у хирурга робот-ассистированная простатэктомия может стать методом выбора в лечении пациентов с большим объемом предстательной железы. 

Introduction

Introduction. According to scientific studies, adenocarcinoma coincides with adenomatous tissue within the same prostate gland in 10–83.3 % of cases (including incidental cancer). Clinical situations in which the adenoma reaches a significant size (typically greater than 80 cm3 ) and thus creates considerable difficulties for surgeons occurs in not more than in 8–10 % of all cases of prostatectomy. Given the limitations of external beam radiotherapy and brachytherapy related with prostate volume and poor quality of urination, radical prostatectomy in this group of patients remains the treatment of choice. Features of adenoma, such as large median and lateral lobes, the presence of cystostomy and bladder stones, significantly complicate operational benefits. When an enlarged prostate is one of the factors prior to surgery, robotic technology may have certain advantages.

The main goal of this work is to demonstrate the technical advantages of robot-assisted prostatectomy associated with enlarged prostate.

Results and discussion

Results and discussion. We describe the anatomical landmarks and possible surgical methods for overcoming different variations of benign hyperplasia of the prostate using robot-assisted prostatectomy. This information is particularly useful to surgeons aiming to master robotic surgical platforms. Robot-assisted prostatectomy can be effectively used in the treatment of prostate cancer associated with benign prostatic hyperplasia, and patients can have confidence in the results of such an operation.

Conclusion

Conclusion. If a surgeon is sufficiently experienced, robot-assisted prostatectomy may become the method of choice in the treatment of patients with enlarged prostates. 

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The authors declare that there are no conflicts of interest present.