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Robotisch assistierte laparoskopische partielle Nephrektomie

Funktionelle und onkologische Ergebnisse

Robot-assisted laparoscopic partial nephrectomy

Functional and oncological outcomes

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Zusammenfassung

Hintergrund

In den letzten Jahren wurden kleine Raumforderungen der Niere vermehrt als Zufallsbefund radiologischer oder sonographischer Untersuchungen mit anderer Zielsetzung detektiert. Die organerhaltende Nierentumorresektion hat sich in Form der offenen partiellen Nephrektomie (OPN) international als Referenzstandard der Therapie von Nierentumoren < 7 cm etabliert.

Ergebnisse

Dank der technischen Entwicklung zählen minimal-invasive Verfahren als Alternative zur offenen Nierentumorresektion. Die konventionelle laparoskopische partielle Nephrektomie (LPN) erreicht in erfahrenen Händen vergleichbar gute funktionelle und onkologische Ergebnisse wie die OPN. Die robotisch assistierte laparoskopische partielle Nephrektomie (RAPN) wird seit 2004 durchgeführt und bietet eine weitere minimal-invasive Therapieoption. Im Vergleich zur konventionellen Laparoskopie bietet die RAPN eine schnellere Lernkurve, eine bessere Visualisation und versatile Instrumentierung dank der Freiheitsgrade der artikulierenden Instrumente. Nach etwa 30 Eingriffen ist ein Erfahrungsgrad erreicht, der durch ein gutes funktionelles Ergebnis, geringeren Blutverlust und kürzere warme Ischämiezeit der Niere im Vergleich zur klassischen Laparoskopie gekennzeichnet ist. Dies wiederum kann zu kürzeren Krankenhausaufenthalten und Ausfallszeiten am Arbeitsplatz führen. Auftretende Komplikationen sind nach der Clavien-Klassifikation mehrheitlich den Graden I und II zuzuordnen und größtenteils konservativ zu behandeln.

Schlussfolgerung

Onkologische Langzeitergebnisse stehen noch aus, weswegen die RAPN noch nicht als gleichwertiges nierenerhaltendes Verfahren im Vergleich zur LPN und OPN bestätigt ist. Bis zum Erreichen besserer Evidenz folgt die Entscheidung der chirurgischen Technik zur Therapie lokal begrenzter Nierentumore dem Wunsch des Patienten, der Ausstattung der jeweiligen Klinik und der Präferenz des Operateurs.

Abstract

Background

In recent years, small renal masses (SRM) have been increasingly detected as an incidental finding of radiological or ultrasound studies for other indications. Organ-sparing renal tumor resection as open partial nephrectomy (OPN) is the international standard for renal tumors <7 cm.

Results

Due to technical developments, minimally invasive procedures have emerged as an alternative to OPN. In experienced hands, conventional laparoscopic partial nephrectomy (LPN) has achieved good functional and oncological results comparable to OPN. Robot-assisted laparoscopic partial nephrectomy (RAPN) has been performed since 2004. Compared to LPN, RAPN provides a faster learning curve, better visualization and more versatile instrumentation due to the degrees of freedom of the articulated instruments. After about 30 procedures, a level of experience is reached, which is characterized by good functional results, less blood loss, and shorter warm ischemia time of the kidney as compared to LPN. This can relate to a shorter hospital stay and faster recovery. Complications according to the Clavien classification are mostly grade I and II and are mainly treated conservatively.

Conclusion

Oncological long-term results are not available yet; so that RAPN cannot be considered as an equivalent treatment to LPN and OPN. Until long-term evidence is available, decisions regarding the surgical technique for organ-sparing renal tumor resection will be determined by patient’s wishes and surgeon’s preference.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F.C. Roos, C. Thomas, A. Neisius, S. Nestler, J.W. Thüroff und C. Hampel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Urologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55101, Mainz, Deutschland

    F.C. Roos, C. Thomas, A. Neisius, S. Nestler, J.W. Thüroff & C. Hampel

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  1. F.C. Roos
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  2. C. Thomas
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  3. A. Neisius
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  4. S. Nestler
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  5. J.W. Thüroff
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  6. C. Hampel
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Correspondence to F.C. Roos.

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Roos, F., Thomas, C., Neisius, A. et al. Robotisch assistierte laparoskopische partielle Nephrektomie. Urologe 54, 213–218 (2015). https://doi.org/10.1007/s00120-014-3670-6

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  • DOI: https://doi.org/10.1007/s00120-014-3670-6

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