Die operative Therapie des Prostatakarzinoms im Wandel – Vergleich zwischen offener und laparoskopisch–roboterassistierter radikaler Prostatektomie

Seit fast 10 Jahren wird neben der offenen und laparoskopischen radikalen Prostatektomie auch die roboterassistierte laparoskopische Prostatektomie angeboten. Neben den allgemeinen Vorteilen minimalinvasiver Verfahren, wie geringeres Gewebetrauma, geringerer Blutverlust und kürzere Krankenhausaufenthaltsdauer, bietet das Operationssystem dem Operateur die Vorteile einer 3–dimensionalen Sicht auf das Operationsgebiet und sämtliche Freiheitsgrade des menschlichen Handgelenks für die intrakorporal liegenden Instrumente. Diesen Vorteilen stehen zum einen die fehlende taktile Rückmeldung an den Operateur, die tendenziell längeren Operationszeiten und die hohen Behandlungskosten entgegen. In den wenigen vergleichenden Studien konnte bisher kein Unterschied bezüglich der mittelfristigen funktionellen und onkologischen Ergebnisse gefunden werden.

Ziel dieses Artikels ist es, dem Leser das roboterassistierte Operationsverfahren zu erläutern und anhand der zur Verfügung stehenden Studien die Unterschiede zur offenen Operation aufzuzeigen.

For nearly ten years now, robotic–assisted laparoscopic prostatectomy has been offered besides open and laparoscopic radical prostatectomy. Apart from the general advantages of minimally invasive procedures such as low tissue trauma, little blood loss and shorter hospital stay, the operation system offers the surgeon the advantages of 3–dimensional view on the operating area and any degrees of freedom of the human wrist joint for the intra–corporally placed instruments. Opposed to these advantages are the lack of tactile feedback to the surgeon, rather longer operating times and high treatment costs. In the few comparative studies no differences with regard to intermediate–term functional and oncological results could be found yet.

The aim of this paper is to explain the robotic–assisted surgical technique to the reader and to comment on the differences to open surgery on the basis of the available studies.

Key words

Robotic–assisted laparoscopic prostatectomy - RALP - radical prostatectomy - RRP - daVinci - minimally–invasive

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