Stellenwert der laparoskopischen radikalen Prostatektomie - Ist ein neuer operativer Standard definiert?

Zusammenfassung

Die laparoskopische radikale Prostatektomie ist mittlerweile ein genau standardisierter Eingriff, der an einigen spezialisierten Zentren durchgeführt wird. Obwohl onkologische Daten im Langzeitverlauf fehlen, scheinen aktuelle Studien darauf hinzudeuten, dass die entsprechenden Erwartungen in diesen Eingriff erfüllt werden können. Bessere onkologische Resultate im Vergleich zu den offenen chirurgischen Therapien sind jedoch nicht zu erwarten. Minimale Vorteile der laparoskopischen gegenüber den offenen Operationsverfahren liegen im Bereich der Kosmetik der Operationswunde, einem geringfügig kürzeren Krankenhausaufenthalt, etwas geringeren postoperativen Schmerzen und einer niedrigeren Transfusionsrate. Andererseits handelt es sich bei der laparoskopischen radikalen Prostatektomie um eine operative Herausforderung - selbst in der Hand des laparoskopisch versierten Urologen. Es erscheint nicht praktikabel, dieses Verfahren von jedem Urologen erlernen zu lassen.

Summary

Laparoscopic radical prostatectomy is now a well standardized procedure that is used in several specialized centres. Although long term oncologic data are still lacking, based on several contemporary series, it seems likely that oncologic results will fulfil expectations. Better oncological results compared to open surgical procedures could not be expected. Minimal advantages of laparoscopy over open surgery include minimal disfigurement, little shorter hospital stay, a little less decreased postoperative discomfort, and lower transfusion rate. On the other hand laparoscopic radical prostatectomy is an extremely challenging procedere for even experienced laparoscopic surgeons, and it is not practical to expect most urologists to learn this technique.

Key Words

prostate cancer - laparoscopy - retropubic operation

Literatur

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