Zusammenfassung
Die Entwicklung der Nierenbeckenplastik war ein wichtiger erster Schritt zur Einführung und Entwicklung laparoskopischer Nahttechniken. Die Akzeptanz der Nierenbeckenplastik war aber primär gering. Der entscheidende Durchbruch kam mit der Entwicklung der radikalen Prostatektomie, die mit der Harnröhrenanastomose ein wesentliches rekonstruktives Element enthält. Jeder laparoskopische Operateur war nun gezwungen, sich ernsthaft mit Nahttechniken auseinanderzusetzen. Dadurch stieg rasant das Interesse an weiteren rekonstruktiven Eingriffen.
Die laparoskopische Nierenbeckenplastik hat sich in kurzer Zeit zu einem Standard entwickelt. Die Ergebnisse sind gleich gut wie die der offenen Operation. Verschiedene Techniken der Harnleiterneuimplantation wurden beschrieben. Technisch relativ einfach ist die laparoskopische Harnleiterneuimplantation mit der Psoas-hitch-Technik, die allerdings von der offenen Methode abweicht. Ein potentiell großes Krankengut erschließt sich mit der Sakrokolpopexie zur Behandlung des Genitalprolapses. Die Langzeitergebnisse sind mit einer Erfolgsrate von 92% ausgezeichnet. Die Harnableitung im Rahmen einer Zystektomie erfolgt vorwiegend laparoskopisch assistiert.
Abstract
The introduction of laparoscopic pyeloplasty was the first step towards the development of suturing and knotting techniques. The final breakthrough came with the development of radical prostatectomy since the performance of the urethrovesical anastomosis required highly developed skills in reconstructive surgery. For most laparoscopic surgeons suturing and knot tying became quite familiar henceforth. As a consequence, the interest for other reconstructive procedures has increased tremendously since.
Within a very short time pyeloplasty was developed to a surgical standard, and the results compare very favorably with open surgery. A very attractive method is the ureteral reimplantation according to the psoas hitch technique, which, however, does not completely duplicate the open surgical operation. Many patients can potentially be attracted by sacrocolpopexy to treat genital prolapse. The long-term success rate is 92% which is excellent for this indication. Urinary diversion following cystectomy is usually not performed completely intracorporeally, but laparoscopically assisted.
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Janetschek, G. Rekonstruktive laparoskopische Eingriffe in der Urologie. Urologe 45, 1127–1134 (2006). https://doi.org/10.1007/s00120-006-1155-y
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DOI: https://doi.org/10.1007/s00120-006-1155-y