Introduction

Robot-assisted radical prostatectomy (RARP) is a treatment option for men with localised prostate cancer. The challenge of RARP consists in competing oncological and functional goals. The most common side effects following RARP are urinary incontinence and erectile dysfunction, occurring in 74% and 79%, respectively, of participants in the PROTECT study, a prospective randomised trial conducted in the United Kingdom [1]. These results contrast with single-institution cohort studies from high-volume centres, which have reported urinary incontinence and erectile dysfunction in as few as 11% and 34% of participants, respectively, 3 years after RARP [2]. These differences may be attributable to patient selection, differences in outcome definitions, and/or differences in surgical technique.

The hypothesis that the surgical technique influences the outcome has led to several modifications of RARP that aim to preserve and/or reconstruct the delicate periprostatic structures to improve functional outcomes. Previous surgical techniques have attempted to preserve or reconstruct several periprostatic structures, including the puboprostatic ligament complex, Denonvilliers' fascia, neurovascular bundles, bladder neck and urethra, endopelvic fascia, accessory pudendal arteries, and Santorini complex.

Inspired by Dr. Richard Gaston's laparoscopic technique, we illustrate a robotic surgery technique that preserves all periprostatic structures to facilitate early return of continence and erectile function, after which the preserved periprostatic anatomical structure has the appearance of an igloo. Our primary aim in this study was to describe the surgical steps of the novel standardised ‘igloo’ technique (Video S1). The secondary aim was to present the early functional and oncological outcomes of this technique.

中文翻译：

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用于机器人辅助根治性前列腺切除术的“冰屋”技术——最大程度地保留神经，以尽早恢复节制和性功能

介绍

机器人辅助根治性前列腺切除术（RARP）是针对患有局限性前列腺癌的男性的一种治疗选择。 RARP 的挑战在于肿瘤学和功能目标的竞争。 RARP 后最常见的副作用是尿失禁和勃起功能障碍，在英国进行的一项前瞻性随机试验 PROTECT 研究中，分别有 74% 和 79% 的参与者出现尿失禁和勃起功能障碍 [ 1 ]。这些结果与来自大容量中心的单机构队列研究形成鲜明对比，后者报告 RARP 3 年后，尿失禁和勃起功能障碍的参与者分别只有 11% 和 34% [ 2 ]。这些差异可能归因于患者选择、结果定义的差异和/或手术技术的差异。

手术技术影响结果的假设导致了 RARP 的一些修改，旨在保留和/或重建精致的前列腺周围结构，以改善功能结果。以前的手术技术试图保留或重建几种前列腺周围结构，包括耻骨前列腺韧带复合体、Denonvilliers筋膜、神经血管束、膀胱颈和尿道、盆腔内筋膜、阴部副动脉和圣托里尼复合体。

受理查德·加斯顿博士的腹腔镜技术的启发，我们展示了一种机器人手术技术，该技术保留了所有前列腺周围结构，以促进节制和勃起功能的早期恢复，之后保留的前列腺周围解剖结构具有冰屋的外观。我们在这项研究中的主要目的是描述新型标准化“冰屋”技术的手术步骤（视频 S1）。第二个目的是展示该技术的早期功能和肿瘤学结果。