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Laparoskopische Beckenchirurgie

Wo stehen wir im Jahr 2006?

Laparoscopic pelvic surgery

Where do we stand in the year 2006?

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Zusammenfassung

Die laparoskopische radikale Prostatektomie (LRP) gilt inzwischen als äquieffektives Verfahren im Vergleich zum offenen retropubischen Eingriff mit den Vorteilen der minimal-invasiven Chirurgie und wird zunehmend in deutschen Kliniken eingesetzt. Unklar ist, ob sich hierfür der Operationsroboter da Vinci – ähnlich wie in den USA – durchsetzen wird, da einer breiten Anwendung die hohen Anschaffungs- und Unterhaltkosten gegenüber stehen. Auch die laparoskopische Sakrokolpopexie zur Behandlung von massiver Zysto- bzw. Rektozele mit oder ohne Stressinkontinenz gilt an Zentren als gleichwertiger Eingriff zur offenen transabdominellen bzw. transvaginalen Operation mit geringer Belastung für die Patientinnen.

Der Stellenwert der radikalen Zystektomie ist – trotz erwiesener Machbarkeit – umstritten. Einserseits führen die technischen Schwierigkeiten bei rein laparoskopisch durchgeführter Harnableitung zu langen Operationszeiten, während beim laparoskopisch assistierten Vorgehen sich die Frage nach dessen Vorteil im Vergleich zur primär offenen Operation stellt. Andererseits deuten die bisher vorliegenden onkologischen Ergebnisse mit Lokalrezidiven und Fernmetastasen in bis zu 30% zumindest auf eine unzureichende Patientenselektion hin. Das Verfahren sollte nur auf wenige Zentren beschränkt bleiben.

Abstract

Laparoscopic radical prostatectomy has become an equivalent alternative to the open retropubic approach, offering the advantages of minimally invasive surgery. It is being applied increasingly in Germany and the rest of Europe. Whether the surgical robot da Vinci will be used for this procedure to the same extent as in the United States is unpredictable because of high investment and maintenance costs. Similarly, laparoscopic sacrocolpopexy has proven to be a viable option compared to open transabdominal or transvaginal surgery, showing a significant reduction in postoperative morbidity.

The value of radical cystectomy is controversial despite proven feasability. On one hand, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times, and in the case of the laparoscopically assisted creation of a neobladder, the advantage of this approach has to be questioned. On the other hand, a maximum rate of 30% of local recurrences and distant metastases indicates at least poor patient selection. In conclusion, this procedure should be limited to a few experienced centers.

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Authors and Affiliations

  1. Urologische Klinik, SLK-Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg, Am Gesundbrunnen 20, 74074, Heilbronn

    J. Rassweiler & D. Teber

  2. Department of Urology, Amsterdam Medical Center, Amsterdam, Niederlande

    J. de la Rosette & P. Laguna

  3. Vincenzo Pansodoro Foundation, S. Giovanni-Addolorata Hospital, Rom, Italien

    V. Pansodoro

  4. Urologische Abteilung, Helios-Kliniken, Müllheim

    T. Frede

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  1. J. Rassweiler
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  2. D. Teber
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  3. J. de la Rosette
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  4. P. Laguna
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  5. V. Pansodoro
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Correspondence to J. Rassweiler.

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Rassweiler, J., Teber, D., de la Rosette, J. et al. Laparoskopische Beckenchirurgie. Urologe 45, 1135–1144 (2006). https://doi.org/10.1007/s00120-006-1151-2

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