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Roboterassistierte laparoskopische radikale Zystektomie

Robot-assisted laparoscopic radical cystectomy

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Zusammenfassung

In unterschiedlichen Arbeiten wurde bisher prinzipiell die Machbarkeit einer laparoskopischen Zystektomie gezeigt. Der Sinn dieser Vorgehensweise wird aber vor allem aufgrund längerer Operationszeiten und einer fraglichen Tumorkontrolle in Frage gestellt. Nach Etablierung der radikalen Prostatektomie (n=650) beschreiben wir unsere Erfahrungen und Ergebnisse mit der DaVinci-Zystektomie.

Insgesamt 27 Patienten (24 Männer), die von Januar 2004 bis Dezember 2006 mit dem DaVinci-System operiert wurden, konnten in der aktuellen Arbeit berücksichtigt werden. Die Indikation zur Operation bestand aufgrund eines muskelinvasiven Tumorwachstums (n=24) oder nach Radiatio einer tumortragenden Blase mit konsekutiver Schrumpfblase (n=4). Bei allen Patienten erfolgte eine pelvine Lymphadenektomie. Als Harnableitung erfolgte bei 19 Patienten die Anlage eines Ileumconduits, 8 Patienten erhielten eine Ileumneoblase.

Die mittlere Operationszeit lag bei 340 min (Spanne: 150–450 min), bei einem durchschnittlichen Blutverlust von 301 ml (Spanne: 50–550 ml). Die Anzahl an entnommenen Lymphknoten wurde mit 23 bestimmt. Bei einem Patienten ergab die histologische Untersuchung einen positiven Schnittrand.

Nach einem mittleren Follow-up von 10,2 Monaten wurden 2 perioperative Komplikationen (Anastomosenlekage, Adhäsionen) und 3 postoperative Komplikationen (Ileus, Dünndarmfistel) festgestellt. Nach nerverhaltender Operation berichteten 6/7 Patienten über eine zufriedenstellende postoperative Erektion. Kontinent waren nach durchschnittlich 3,5 Monaten 7/8 Patienten.

Die roboterunterstützte laparoskopische Zystektomie ist eine sichere und komplikationsarme Operationsmethode. Bei akzeptablen Operationszeiten können exzellente funktionelle und onkologische Ergebnisse erreicht werden.

Abstract

Recent reports have demonstrated that robot-assisted laparoscopic cystectomy is technically feasible. However, wide-spread acceptance of this promising technique is limited due to long operating times and lacking long-term data especially on oncological outcome. After establishing robot-assisted laparoscopic prostatectomy (n=250) we report technical and functional results of a large series of patients undergoing laparoscopic cystectomy with the da Vinci surgical system (DVSS).

27 patients (24 males) underwent laparoscopic radical cystectomy with the DVSS (Intuitive Surgical) between Jan 2004 and Dec 2006. Indications for cystectomy were muscle-invasive transitional cell carcinoma (TCC) or leiomyosarcoma of the urinary bladder (n=24) and bladder shrinking following prior radiotherapy for TCC (n=3). A pelvic lymphadenectomy was routine part of the procedure. Urinary diversions were ilieal conduits (n=19) and ileal neobladders (n=8).

Mean operating time was 340 minutes (range 150–450) with a mean blood loss of 301 mL (range 50–550). The mean number of lymph nodes retrieved during lymphadenectomy was 23. Surgical margins were negative except in one case. After a mean follow-up of 10.2 months, 2 perioperative (anastomotic leakage, adhesions) and 3 postoperative complications (ileus, intestinal fistula) occurred. 6/7 patients reported satisfying erectile function following nerve-sparing surgery. Day-time continence was completely restored after a mean 3.5 months in 7/8 patients.

Robot-assisted laparoscopic cystectomy is a safe procedure. Satisfying functional and oncological short-term results can be achieved within acceptable operating time limits.

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Authors and Affiliations

  1. Department of Urology, Onze-Lieve-Vrouw Clinic, Moorselbaan 164, 9300, Aalst, Belgien

    A. Mottrie, P. Schatteman & E. Fonteyne

  2. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    J. Rotering, M. Stöckle & S. Siemer

Authors
  1. A. Mottrie
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  2. P. Schatteman
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  3. E. Fonteyne
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  4. J. Rotering
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  5. M. Stöckle
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  6. S. Siemer
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Correspondence to A. Mottrie.

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Mottrie, A., Schatteman, P., Fonteyne, E. et al. Roboterassistierte laparoskopische radikale Zystektomie. Urologe 47, 414–419 (2008). https://doi.org/10.1007/s00120-008-1655-z

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