良性攝護腺增生（BPH）是影響老年男性生活品質的重要疾病。對於體積大於80ml以上的患者，若藥物無效，傳統會建議進行開放性或經腹腔的攝護腺切除術（simple prostatectomy）。然而，這些手術方式侵入性較高，復原時間長，併發症風險也相對較高。近年來，機器手臂輔助的微創手術已被廣泛應用。尤其是達文西單孔系統（da Vinci SP system）可經單一切口完成複雜手術。本研究探討經膀胱途徑的單孔機器手臂輔助攝護腺切除術（single-port transvesical robot-assisted simple prostatectomy, SP-TV-RASP）之安全性、技術細節與臨床效果。

此為為回溯性單中心研究，納入28位攝護腺體積大、排尿困難且經藥物治療無效的男性患者，皆由同一名經驗豐富的泌尿科醫師操作SP系統。手術經恥骨上膀胱穿刺切口進入，於膀胱內環狀剝離增生腺體，保留攝護腺包膜，最後止血處理並修補膀胱頸與黏膜。所有手術皆於達文西SP平台下完成，無需另加輔助切口。

根據研究結果，進行單孔經膀胱機器手臂輔助攝護腺切除手術（SP-TV-RASP）的病患，其平均年齡為 68.8 歲，大多為高齡男性。接受手術的患者平均攝護腺體積達 162.5ml。手術本身平均耗時約 184分鐘，術後平均住院時間為 5 天，導尿管則平均保留約3天。無術後短期併發症發生。

功能改善方面顯著，術後患者術前的國際攝護腺症狀評分（IPSS）大幅改善；此外，最大尿流速（Qmax）、殘餘尿量（PVR）亦明顯下降，且病患生活品質也顯著進步。

本研究顯示，單孔機器手臂輔助經膀胱攝護腺切除術（SP-TV-RASP）是一項安全、有效，且具美觀與微創優勢的手術方式，特別適用於中大型攝護腺體積患者。其手術經由恥骨上進入膀胱內操作，無需進入腹膜腔，可有效降低腸道干擾與腹腔沾黏的風險；此路徑也避免與盆腔其他器官產生黏連，因此特別適合曾接受腹腔手術族群。此外，單一切口設計美觀且術後疼痛感較低，有助於病患快速恢復並提升術後生活品質。

Background: Surgical management of large prostatic adenomas can be performed via open, endoscopic, or robotic approaches. A low-profile single-port (SP) robot was built to work in confined areas (ie, the bladder) and regionalize surgery.

Objective: To describe the novel SP transvesical (TV) robot-assisted simple prostatectomy (RASP) and report clinical outcomes.

Design, setting, and participants: SP TV RASP cases were performed in an academic hospital by two surgeons from 2019 to 2023. A total of 117 cases were performed, and data from patients with at least 12 mo of follow-up were analyzed. The inclusion criterion was severe obstructive urinary symptoms or catheter-dependent urinary retention due to large prostates with volume >80 ml.

Surgical procedure: The procedure consisted of two main steps through a single 3-cm suprapubic incision: first, enucleation of the adenoma, and second, a 360° bladder mucosal flap reconstruction. No drains or continuous bladder irrigation was used routinely.

Measurements: Intraoperative parameters, pre- and postoperative uroflowmetry, and 1-yr clinical outcomes were assessed. We used descriptive statistics to analyze the data.

Results and limitations: All procedures were completed successfully without additional ports or conversions. The median console time and estimated blood loss were 107 min and 100 ml, respectively. Transfusion rate was 0%. Intraoperative complications included two suspected air emboli attributed to high insufflation pressures. There were no major postoperative complications. In total, 95.8% were discharged within the first 24 h, with a median length of stay and pain score of 5 h and 3/10, respectively. There was persistent improvement in the median International Prostate Symptom Score and flow rate after 1 yr. The median Sexual Score Inventory for Men score was 20 at 12 mo. Our study is limited by its retrospective nature and cohort size.

Conclusions: SP TV RASP is a feasible alternative for the management of severe benign prostatic hyperplasia that promotes fast recovery and demonstrates 1-yr improvement in urinary function.