Urethrale Anastomose bei orthotopem Blasenersatz nach roboterassistierter radikaler Zystektomie (RARC) an deutschsprachigen Robotikzentren

Zusammenfassung

Einleitung:

Nach roboterassistierter radikaler Zystektomie (RARC) und extrakorporaler Rekonstruktion werden zur urethroneovesikalen Anastomose beim orthotopen Blasenersatz robotisch fortlaufend genähte Techniken und solche mit offen oder robotisch vorlegten Einzelknopffäden verwendet.

Methode:

In einer online Umfrage wurde an 62 deutschsprachigen Robotikzentren erfragt, ob an den jeweilige Zentren RARCs durchführt werden. Wurde die Frage bejaht, wurden weitere Fragen zur Art des Blasenersatzes und zur Technik der urethroneovesikalen Anastomose gestellt.

Ergebnisse:

Die Rücklaufquote der online Fragebögen lag bei 80% (n=50). 44% (n=22) der Zentren mit Rückantwort gaben an, die RARC durchzuführen. Der Umfrage zu folge berichteten alle Zentren bis auf eins, die Rekonstruktion der Neoblase extrakorporal durchzuführen [Studerblase 73% (n=16), Hautmannblase 18% (n=4) und andere 9% (n=2)]. Nach Rekonstruktion der Neoblase gaben 36% (n=8) der Robotikteams an, die Anastomose mit offen operativ vorgelegten, 24% (n=5) die Anastomose mit robotisch vorgelegten Einzelfäden zu knoten und 40% (n=9) sie fortlaufend robotisch nach Neuandocken des Roboterstativs oder im Rahmen der intrakorporalen Rekonstruktion zu nähen.

Schlussfolgerung:

Nach der vorliegenden Umfrage werden im deutschsprachigen Raum nach extrakorporaler Rekonstruktion meist mit einer Studer Blase am häufigsten Anastomosentechniken mit vorgelegten Einzelknopfnähten verwendet. Diese bieten den Vorteil, dass auf ein Neuandocken des Roboters verzichtet werden kann. Allerdings muss über die Laparotomie genügend Platz zum offenen Knoten der Anastomose vorhanden sein.

Abstract

Introduction:

Following robot-assisted radical cystectomy (RARC) and extracorporeal reconstruction, robotic continuous suture techniques and those using open or robotically pre-positioned single sutures are used for the urethroneovesical anastomosis.

Methods:

62 German-speaking robotic centres were asked in an online questionnaire whether they carried out RARC. Following an affirmative answer further questions were put to the form of the neobladder and the technique of the urethrovesical anastomosis.

Results:

80% of the online questionnaires were answered. 44% (n=22) of these centres perform the RARC. According to the answers, given all of the centres but one perform an extracorporeal construction of the neobladder [Studer bladder 73% (n=16), Hautmann bladder 18% (n=4), others 9% (n=2)]. After reconstruction 36% (n=8) of the teams perform a completely open surgical anastomosis with pre-positioned sutures, 24% (n=5) close the anastomosis in a single knot technique using robotically pre-positioned sutures and 40% (n=9) use continuous sutures during the intracorporeal reconstruction or after re-docking the robot.

Conclusion:

According to this questionnaire to German-speaking centres the most common anastomotic technique following extracorporeal reconstruction, mostly a Studer bladder, is that of the pre-positioned single knot sutures. This offers the advantage that a re-docking of the robotic cart is unnecessary. In contrast, however, to robotically performed suturing, there must be enough space in the open procedure to surgically tie-off the sutures of the anastomosis.

Schlüsselwörter

Blasenkrebs - roboterassistierte radikale Zystektomie (RARC) - Neoblase - urethrale Anastomose

Key words

bladder cancer - robot-assisted radical cystectomy (RARC) - neobladder - urethral anastomosis

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