Roboterassistierte Harnblasendivertikelresektion (RAHDR)

Zusammenfassung

Ziele Seit Oktober 2018 werden Harnblasendivertikelresektionen in der Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie der Sozialstiftung Bamberg roboterassistiert und minimalinvasiv, mit dem DaVinci-Operationssystem^®, durchgeführt. Das Ziel dieser Arbeit ist die operativen Ergebnisse unserer Patienten zu objektivieren und mit anderen Daten zu vergleichen, um ggf. die Diagnostik und Therapie zu optimieren.

Methoden In dieser retrospektiven Analyse haben wir alle Patienten, die zwischen Oktober 2018 und Mai 2020 eine RAHDR erhalten haben, eingeschlossen. Die primären Endpunkte waren: der intraoperative bzw. postoperative Blutverlust (Hämoglobin-Abfall postoperativ), die Operationszeit (min), die Hospitationsdauer (Tage), der postoperative Restharn, das Auftreten von Anastomoseninsuffizienzen, die postoperative Lebensqualität und die postoperative Zufriedenheit mit den Miktionsverhältnissen.

Ergebnisse Es konnten insgesamt 11 Patienten eingeschlossen werden. Das mittlere Alter betrug 64,8 Jahre (52–82) und alle Patienten waren männlich. Der durchschnittliche BMI war 26,5 kg/m² (19–37). 3 Patienten wurden mit ASA-Score III eigestuft, 5 mit II und 3 mit I. Der durchschnittliche Restharnwert präoperativ lag bei 183 ml (90–240). 7 von 11 Patienten bekamen simultan eine oder 2 weitere Operationen. Ein Zystogramm zum Ausschluss einer Extravasation erfolgte am fünften bzw. sechsten postoperativen Tag. Die mittlere Operationszeit war 212 min (148–294) und die mittlere Hospitationsdauer betrug 7,6 Tage (6–10). Der durchschnittliche postoperative Restharnwert war 25 ml (10–60). Die durchschnittliche postoperative maximale Harnflussrate (max. Flow) wurde mit 27,7 ml/s (11–55) gemessen. Bei keinem der Patienten wurde eine Kontrastmittelextravasation im Zystogramm nachgewiesen. Die Komplikationen nach Clavien waren nicht objektivierbar. Der mittlere postoperative Hb-Abfall betrug 1,61 g/dl (0–3,2).

Schlussfolgerungen In den meisten Fällen ist die Entfernung eines oder mehrerer Blasendivertikel über die minimalinvasive roboterassistierte Technik möglich. Dabei ist die Möglichkeit gegeben verschiedene Operationen wie YV-Blasenhalsplastik, Prostataadenomenukleation, Blasensteinsanierung, Leistenherniotomie u. a. simultan durchzuführen. Eine roboterassistierte Harnblasendivertikelresektion ist ein effektives und schonendes Verfahren, welches aber, durch fehlende DRG-Abbildung, finanzielle Nachteile für den Leistungserbringer verursachen kann.

Abstract

Aims Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic system^TM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy.

Methods In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition.

Results We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52–82). Average BMI was 26.5 (19–37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90–240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148–294) and the mean duration of hospitalisation was 7.6 days (6–10). The mean residual urinary value after surgery was 25 ml (10–60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11–55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0–3. 2).

Conclusions In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).

Schlüsselwörter

Roboterassistierte laparoskopische Harnblasendivertikelresektion - roboterassistierte Operation - Harnblasendivertikel

Keywords

Robotic-assisted laparoscopic bladder diverticulum resection - robotic surgery - bladder diverticulum

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