Operative Zugangswege in der gynäkologischen Onkologie

Kernaussagen

In der gynäkologischen Onkologie gibt es 4 Zugangswege: vaginaler Zugang, konventionelle Laparoskopie, roboter-assistierte Laparoskopie, Laparotomie.

Die perioperative antibiotische Prophylaxe richtet sich im Wesentlichen nach patientenbezogenen Risikofaktoren und der Art der Operation und nicht nach dem Zugangsweg.

Die offene Eingangstechnik stellt neben der direkten Trokarinsertion die komplikationsärmste Variante für das Anlegen des Pneumoperitoneums im Rahmen der Laparoskopie dar.

Das Risiko für Trokarhernien hängt entscheidend von dem verwendeten Trokardurchmesser ab und ist bei schneidenden Trokaren erhöht.

In der operativen Therapie des frühen Endometriumkarzinoms stellt die konventionelle Laparoskopie den Zugangsweg der Wahl dar.

In der operativen Therapie des Zervixkarzinoms wird die Laparoskopie immer häufiger eingesetzt. Die Datenlage zur onkologischen Sicherheit fehlt dafür derzeit allerdings noch.

In der operativen Therapie des Ovarialkarzinoms stellt die Laparotomie sowohl bei der Staging-Operation des frühen Ovarialkarzinoms als auch der zytoreduktiven Operation des fortgeschrittenen Ovarialkarzinoms den Zugangsweg der Wahl dar.

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