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Zentralbl Chir 2016; 141(05): 538-544
DOI: 10.1055/s-0035-1545904
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

CAMIC-Empfehlungen zur chirurgischen Laparoskopie aus nicht geburtshilflicher Indikation während der Schwangerschaft

CAMIC Recommendations for Surgical Laparoscopy in Non-Obstetric Indications during Pregnancy
S. Förster
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt, Rostock, Deutschland
,
T. Reimer
2   Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock
,
S. Rimbach
3   Landeskrankenhaus Feldkirch, Gynäkologie und Geburtshilfe, Feldkirch, Österreich
12   Für die Arbeitsgemeinschaft Gynäkologische Endoskopie (AGE) der DGGG
,
F. Louwen
4   Klinik für Frauenheilkunde und Geburtsmedizin, Universitätsklinikum Frankfurt am Main
13   Für die Arbeitsgemeinschaft für Geburtshilfe und Pränatalmedizin (AGG) der DGGG
,
T. Volk
5   Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Saar
14   Für den wissenschaftlichen Arbeitskreis Regionalanästhesie und geburtshilfliche Anästhesie der DGAI
,
H. Bürkle
6   Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg
14   Für den wissenschaftlichen Arbeitskreis Regionalanästhesie und geburtshilfliche Anästhesie der DGAI
,
C. Benecke
7   Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
11   Für die Chirurgische Arbeitsgemeinschaft Minimal-Invasive Chirurgie (CAMIC) der DGAV
,
T. Carus
8   Klinik für Allgemin-, Viszeral- und Unfallchirurgie, Klinikum Bremen Ost
11   Für die Chirurgische Arbeitsgemeinschaft Minimal-Invasive Chirurgie (CAMIC) der DGAV
,
A. Türler
9   Klinik für Allgemein- und Viszeralchirurgie, Johanniter-Klinikum Bonn
11   Für die Chirurgische Arbeitsgemeinschaft Minimal-Invasive Chirurgie (CAMIC) der DGAV
,
C. Wullstein
10   Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Helios Klinikum Krefeld
11   Für die Chirurgische Arbeitsgemeinschaft Minimal-Invasive Chirurgie (CAMIC) der DGAV
,
K. Ludwig
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt, Rostock, Deutschland
11   Für die Chirurgische Arbeitsgemeinschaft Minimal-Invasive Chirurgie (CAMIC) der DGAV
› Author Affiliations
Further Information

Publication History

Publication Date:
23 July 2015 (online)

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Zusammenfassung

In der operativ chirurgischen Grundversorgung hat sich die laparoskopische Operationstechnik in den letzten Jahren fest etabliert. Inzwischen werden in der Normalpopulation über 90 % aller Cholezystektomien und über 80 % aller Appendektomien minimalinvasiv durchgeführt. Die nachgewiesenen Vorteile der laparoskopischen Operationstechnik liegen gegenüber konventionell offenen Operationen in einer vergleichsweise schnelleren frühpostoperativen Erholung mit frühzeitiger Wiederaufnahme der allgemeinen körperlichen sowie beruflichen Aktivität. Da diese Vorteile gleichermaßen für notwendige Eingriffe während einer Schwangerschaft nachweisbar sind, wurde in den letzten Jahren auch während der Schwangerschaft zunehmend minimalinvasiv aus nicht geburtshilflicher Indikation operiert. Insgesamt ist davon auszugehen, dass derartige Eingriffe bei ca. 2 % der schwangeren Patientinnen durchgeführt werden müssen. Zahlreiche Studien konnten dabei belegen, dass der Einsatz laparoskopischer Techniken insbesondere für die werdende Mutter sicher und nicht mit einem erhöhten Risiko verbunden ist. Auf der anderen Seite macht die bestehende Schwangerschaft ein adaptiertes Vorgehen bei der Lösung chirurgischer Probleme erforderlich, um den Schutz des ungeborenen Kindes zu gewährleisten. Unter Zugrundelegung der aktuell verfügbaren Datenlage werden Empfehlungen formuliert, die für eine Vielzahl klinischer Situationen als Entscheidungshilfe herangezogen werden können.

Abstract

In the operative surgical primary care, the laparoscopic surgical technique has firmly established itself in recent years. Meanwhile, in the normal population over 90 % of all cholecystectomies and over 80 % of all appendectomies are performed in a minimally invasive manner. The proven benefits of the laparoscopic surgical technique, compared with conventional open surgery, are a comparatively rapid early postoperative recovery with early resumption of the general physical and occupational activity. As these benefits are equally applicable for necessary interventions during pregnancy, in recent years laparoscopy has become the preferred treatment for non-obstetric indications in the gravid patient. Overall, it can be assumed that such interventions have to be performed in approximately 2 % of all pregnant patients. Numerous studies have proven here that the use of laparoscopic techniques, in particular for the expectant mother, is safe and not associated with an increased risk. On the other hand, the current pregnancy makes necessary an adapted approach to the solution of surgical problems to ensure the protection of the unborn child. On the basis of currently available data situation, recommendations are formulated which can be used as a decision-making support for a variety of clinical situations.

Schlüsselwörter

chirurgische Laparoskopie - Schwangerschaft - Empfehlungen

Key words

surgical laparoscopy - pregnancy - guidelines
 

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