Minimally invasive radical prostatectomy for prostate cancer (prostate cancer)
Such a little engaging method promises faster healing with fewer complications and equally good results as open surgery. In 2006 there were on the German Association of Urology congress this, new studies.High-tech methods
Undoubtedly the most spectacular developments are robotic systems to radical prostatectomy.They have been around for some time kept catchment, particularly in the U.S., where already 40% of the operations are performed with it. Access is via small incisions and does not lead through the abdomen. The results tend to be better than that of the open (via laparotomy) and endoscopic (by "mirroring") operation, and the complications are comparable. This, however, only after a "learning curve" of the surgeon, speak only with some experience. Another disadvantage is the high acquisition and maintenance costs, which in this country make it difficult to spread. However, the big advantage is the precise guidance of the instruments in a confined space.
This advantage makes use of a new mechanical manipulator for the previous endoscopic operation: It is introduced through the endoscope and transfers the movement of the hand grips of the instruments, and vice versa. Thus, the operator, in contrast to the robot system, even feel the tissue. In addition, the costs are significantly lower and the learning curve shorter.
Endoscopic procedures
In contrast to open surgery through a long incision in the lower abdomen, radical prostatectomy (RPE) is performed here through an endoscope and other instruments that are inserted through only small incisions ('keyhole surgery'). For prostate then you get either through the abdomen (laparoscopic RPE, LRPE) or outside of the peritoneum (the peritoneum, thus endoscopic extraperitoneal RPE, EERPE). In the latter case, the path runs along behind the pubic bone (pubic bone) as in the open-top variant, which therefore retropubic RPE (RRPE) is called.
The EERPE (endoscopic extraperitoneal RPE) is the newer procedure and involves a lower risk of bowel injury as the LRPE (laparoscopic RPE) with a shorter operative time. The results are similar, at least in the first six months after surgery. For both methods, a protection of the erection nerves is possible, and in both a possible overweight patient hardly matters (as we reported, see nerve sparing during radical prostatectomy and radical prostatectomy in obese men ).
Three other studies were to LRPE still presented: the first had the frozen section analysis the subject. This refers to the removal and immediate histological (tissue) examination of tissue specimens during surgery. So possibly can further tissue be removed, which reduces the risk of incomplete tumor removal. It would point in the subsequent histology of the removed tissue that the tumor reaches the tissue edge (positive surgical margins, R1-finding). Such findings arrived since the introduction of the fast section at the LRPE but are less common.
In the second study focused on the influence of TURP (transurethral resection of the prostate, p surgical procedure for BPH treatment ). It was found that after previous TURP, the rate of incontinence (involuntary loss of urine) was slightly increased, but only in the first three months of LRPE. Other differences were not evident. After the third study, finally, in which the participants had answered the questionnaire for continence, incontinence rate in the first year after LRPE seems to be generally slightly higher than after open surgery (RRPE, retropubic RPE).
Perineal radical prostatectomy
The radical prostatectomy from the dam (perineum) from is called perineal RPE (PRPE). Also, it applies because of faster healing than gentler than open surgery, and the preservation of erectile nerves should be easier. The fact that it is a minimally invasive procedure that good and objective (determined by patient questionnaires) subjective results shows has now been confirmed in a study.
The main difference was for a long time that, in addition, a laparoscopic procedure is necessary if the pelvic lymph nodes must be removed. According to a new study, these pelvic lymphadenectomy (PLA) is also on the perineal access possible without any further complications. Laparoscopic goes the PLA, according to another study, even in the sentinel process. For this purpose, the physician injects before the operation a radioactively labeled substance in the prostate, which is transported in the lymph nodes. Can be achieved during the operation, the "sentinel lymph node" (sentinel lymph nodes), which are first infected with the cancer, identified using a special detector (gamma probe) and remove.
Post a Comment