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Roboterassistierte laparoskopische Pyeloplastik bei Erwachsenen

Exzellente Langzeitergebnisse der primären Pyeloplastik

Robot-assisted laparoscopic pyeloplasty in adults

Excellent long-term results of primary pyeloplasty

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Zusammenfassung

Ziel

Mit Entwicklung der roboterassistierten Operationstechnik hat sich die roboterassistierte Pyeloplastik (RAP) als Therapiealternative zur offenen und laparoskopischen Operation etabliert. Aktuell gibt es nur wenige monozentrische Studien mit größeren Fallzahlen und Langzeitergebnissen. Ziel dieser Studie war die Evaluation von perioperativen Komplikationen und der Langzeiterfolgsrate der RAP bei Nierenbeckenabgangstenose.

Material und Methoden

Zwischen 2004 und 2013 wurden 61 Patienten mit klinisch und urodynamisch relevanter Nierenbeckenabgangsstenose von 2 Operateuren mit der transperitonealen RAP nach Anderson-Hynes in unserer Klinik operiert. Variablen wie Blutverlust, perioperative Komplikationen, Operationszeit und Ursache der Nierenbeckenabgangsenge wurden ausgewertet. Die Gesamterfolgsrate wurde anhand der notwendigen Redo-Pyeloplastiken definiert. Zusätzlich wurden die Patienten identifiziert, die einen unzureichenden Abfluss im postoperativen Isotopennephrogramm mit Lasixstimulation oder aufgrund von Beschwerden eine erneute Einlage einer Harnleiterschiene oder Nephrostomie benötigten.

Ergebnisse

Das mediane Patientenalter war 33  Jahre, die mediane Operationszeit betrug 195 min und das mediane Follow-up lag bei 64 Monaten. Eine Konversion zur offenen Operation war nicht erforderlich. Bei einem Patienten wurde eine offene Redo-Pyeloplastik bei Rezidivenge durchgeführt. Somit lag die Gesamterfolgsrate bei 98 %. Bei 3 Patienten war eine transiente Harnleiterschienung oder Nephrostomie bei Infekt erforderlich.

Schlussfolgerung

Unsere Ergebnisse zeigen im 5-Jahres-Langzeitverlauf exzellente Erfolgsraten für die RAP, welche vergleichbar zur Laparoskopie bzw. offenen Operation sind. Die RAP stellt eine sichere chirurgische Methode dar und bietet dabei die Vorteile des minimal-invasiven Zugangs.

Abstract

Purpose

With the development of the robot-assisted surgical technique, robot-assisted pyeloplasty (RAP) has become established as an alternative to open and laparoscopic surgery. Currently there are only a few single-center studies with larger numbers of cases and long-term results. The aim of this study was to investigate perioperative and long-term postoperative success rates of Anderson–Hynes robot-assisted pyeloplasty (RAP) at a single center.

Materials and methods

We retrospectively reviewed our RAP experience of 61 patients performed by two surgeons between 2004 and 2013 regarding operating time, length of hospital stay, perioperative complication, and success. Overall success was measured in terms of necessary redo pyeloplasty. We also identified patients with temporary stent placement due to symptomatic hydronephrosis or with further obstruction in diuretic renography.

Results

Median age, operating time, and follow-up were 33 years, 195 min, and 64 months, respectively. No conversion to open procedure was necessary. The success rate was 98% (n=60) with 1 patient undergoing open redo pyeloplasty due to a recurrent stenosis. Temporary stent placement was required in 3 patients due to pyelonephritis and dilatation.

Conclusion

Satisfying long-term success rates including low complication rates of RAP were obtained in this study. RAP presents a safe and standardized procedure for symptomatic ureteropelvic junction obstruction.

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Abbreviations

RAP:

roboterassistierte Pyeloplastik

ING:

Isotopennephrogramm

NBS:

Nierenbeckenabgangsstenose

Literatur

  1. Scardino PT, Scardino PL (1981) Obstruction at the ureteropelvic junction. In: Bergman H (eds) The ureter. Springer, Berlin Heidelberg New York, pp 697–716

  2. Ficarra V, Iannetti A, Vianello F, Mottrie A (2014) Different pyeloplasty approaches, similar excellent results. Eur Urol 65(2):453–454

    Article  PubMed  Google Scholar 

  3. Gettman MT, Neururer R, Bartsch G, Peschel R (2002) Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology 60(3):509–513

    Article  PubMed  Google Scholar 

  4. Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM (1993) Laparoscopic dismembered pyeloplasty. J Urol 150(6):1795–1799

    CAS  PubMed  Google Scholar 

  5. Bauer JJ, Bishoff JT, Moore RG et al (1999) Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol 162:692

    Article  CAS  PubMed  Google Scholar 

  6. Jarrett TW, Chan DY, Charambura TC et al (2002) Laparoscopic pyeloplasty: the first 100 cases. J Urol 167:1253

    Article  PubMed  Google Scholar 

  7. Kavoussi LR, Peters CA (1993) Laparoscopic pyeloplasty. J Urol 150:1891

    CAS  PubMed  Google Scholar 

  8. Sukumar S, Sun M, Karakiewicz PI et al (2012) National trends and disparities in the use of minimally invasive adult pyeloplasty. J Urol 188(3):913–918

    Article  PubMed  Google Scholar 

  9. Moon DA, El-Shazly MA, Chang CM et al (2006) Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 67(5):932–936

    Article  CAS  PubMed  Google Scholar 

  10. Sundaram CP, Grubb RL, Rehman J et al (2003) Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction. J Urol 169(6):2037–2040

    Article  PubMed  Google Scholar 

  11. Patel V (2005) Robotic-assisted laparoscopic dismembered pyeloplasty. Urology 66:45–49

    Article  PubMed  Google Scholar 

  12. Yanke BV, Lallas CD, Pagnani C et al (2008) The minimally invasive treatment of ureteropelvic junction obstruction: a review of our experience during the last decade. J Urol 180(4):1397–1402

    Article  PubMed  Google Scholar 

  13. Link RE, Bhayani SB, Kavoussi LR (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243(4):486–491

    Article  PubMed Central  PubMed  Google Scholar 

  14. Ferhi K et al (2009) Promising functional outcomes obtained with robot-assisted laparoscopic pyeloplasty: a single-center experience. J Endourol 23(6):959–963

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  16. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    CAS  PubMed  Google Scholar 

  17. Soulié M, Thoulouzan M, Seguin P et al (2001) Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision: comparison of two surgical approaches. Urology 57(3):443–447

    Article  PubMed  Google Scholar 

  18. Singh I, Hemal AK (2010) Robot-assisted pyeloplasty: review of the current literature, technique and outcome. Can J Urol 17(2):5099–5108

    PubMed  Google Scholar 

  19. Schwentner C, Pelzer A, Neururer R et al (2007) Robotic Anderson-Hynes pyeloplasty: 5-year experience of one centre. BJU Int 100(4):880–885

    Article  PubMed  Google Scholar 

  20. Palese MA, Stifelman MD, Munver R et al (2005) Robot-assisted laparoscopic dismembered pyeloplasty: a combined experience. J Endourol 19(3):382–386

    Article  PubMed  Google Scholar 

  21. Van Cangh PJ, Wilmart JF, Opsomer RJ et al (1994) Long-term results and late recurrence after endoureteropyelotomy: a critical analysis of prognostic factors. J Urol 151(4):934–937

    Google Scholar 

  22. Autorino R, Eden C, El-Ghoneimi A et al (2014) Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 65(2):430–452

    Article  PubMed  Google Scholar 

  23. Hsi RS, Holt SK, Gore JL, Harper JD (2014) Trends in followup imaging after adult pyeloplasty. J Urol 191(5):1357–1362. doi:10.1016/j.juro.2013.12.052

    Article  PubMed  Google Scholar 

  24. Madi R, Roberts WW, Wolf JS (2008) Late failures after laparoscopic pyeloplasty. J Urol 71:677–680

    Article  Google Scholar 

  25. Garg M, Singh V, Sinha RJ, Sankhwar SN (2014) Prospective randomized comparison of retroperitoneoscopic vs open pyeloplasty with minimal incision: subjective and objective assessment in adults. Urology 83(4):805–811. doi:10.1016/j.urology.2013.11.024

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Traumann, L.A. Kluth, M. Schmid, C. Meyer, B. Schwaiger, C. Rosenbaum, P. Schriefer, M. Fisch, R. Dahlem, D. Seiler, S. Ahyai, A. Haese und F.K.-H. Chun geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    M. Traumann, L.A. Kluth, M. Schmid, C. Meyer, B. Schwaiger, C. Rosenbaum, P. Schriefer, M. Fisch, R. Dahlem, S. Ahyai & F.K.-H. Chun

  2. Abteilung für Urologie, Kantonsspital Aarau, Aarau, Schweiz

    D. Seiler

  3. Martini-Klinik, Prostatakarzinom Zentrum, Hamburg, Deutschland

    A. Haese

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  1. M. Traumann
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  2. L.A. Kluth
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  3. M. Schmid
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  4. C. Meyer
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  5. B. Schwaiger
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  6. C. Rosenbaum
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  7. P. Schriefer
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  8. M. Fisch
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  9. R. Dahlem
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  13. F.K.-H. Chun
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Correspondence to M. Traumann.

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M. Traumann und L.A. Kluth haben zu gleichen Anteilen an diesem Manuskript beigetragen.

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Traumann, M., Kluth, L., Schmid, M. et al. Roboterassistierte laparoskopische Pyeloplastik bei Erwachsenen. Urologe 54, 703–708 (2015). https://doi.org/10.1007/s00120-014-3654-6

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