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Die roboterassistierte laparoskopische radikale Prostatektomie

Techniken und Standort 2008

Robotic laparoscopic radical prostatectomy

Update 2008

  • Leitthema
  • Published:
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Zusammenfassung

Die kurative chirurgische Therapie beim Prostatakarzinom strebt nach optimaler Tumorkontrolle mit kleinst möglicher Morbidität und bester funktioneller Erhaltung von Kontinenz und Potenz. Mit der Einführung des daVinci-Systems hat sich ein Trend von der offenen zur roboterassistierten laparoskopischen Technik entwickelt, der sich heute v. a. den USA mit größerer Verfügbarkeit der Technologie eindrücklich zeigt. Leider sind die hohen Anschaffungs- und Unterhaltskosten für unsere Gesundheitssysteme nur knapp finanzierbar. Die roboterassistierte laparoskopische radikale Prostatektomie (RLP) verglichen mit der offenen retropubischen radikalen Prostatektomie scheint ebenbürtige frühpostoperative onkologische und funktionelle Resultate zu erreichen bei kleinerer Morbidität. Trotzdem ist die RLP verglichen mit der retropubischen Prostatektomie immer noch in den Kinderschuhen. Um zuverlässige Zahlen über die Inzidenz von RLP-assoziierten Komplikationen zu erhalten, sind gemeinsame interinstitutionelle Erfassungen des onkologischen und funktionellen Outcomes mit validierten Fragebögen gefordert. Die Erfahrung des einzelnen Chirurgen mit seiner Technik und die exakte Indikationsstellung bleiben entscheidender für das onkologische und funktionelle Resultat als das jeweils gewählte Verfahren in der radikalen Prostatektomie – sei es offen oder roboterassistiert laparoskopisch.

Abstract

Radical prostatectomy aims for optimal tumor control, minimal morbidity, and best functional outcomes of urinary continence and erection. With the introduction of the robotic daVinci surgical system an impressive shift from open radical to robotic laparoscopic prostatectomy (RLP) has occurred especially in the USA. Unfortunately, initial and instrumental costs and maintenance fees of the system are still very high. Compared with the open retropubic approach, RLP has a similar short-term outcome in oncological control, potency, and urinary continence but potentially distinctly favorable benefits in blood loss, transfusion rates, and minor complications. However, RLP is still in its infancy compared to open radical prostatectomy. Inter-institutional trials with the same validated questionnaires are necessary for the future to evaluate oncological and functional results conclusively. The individual surgeon’s experience with his routinely preferred technique remains the crucial key for a successful oncological and functional outcome in radical prostatectomy, whatever technology is used.

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John, H. Die roboterassistierte laparoskopische radikale Prostatektomie. Urologe 47, 291–298 (2008). https://doi.org/10.1007/s00120-008-1626-4

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