Minimal-invasive Chirurgie in der Kinderurologie

Zusammenfassung

Die laparoskopische (minimal-invasive) Chirurgie hat sich bei vielen ablativen und rekonstruktiven Eingriffen in der Kinderchirurgie etabliert. Minimal-invasive Techniken sind im Vergleich zu offenen Operationen gleichermaßen effektiv und weisen eine geringere Morbidität und bessere Kosmetik auf. Nun breitet die minimal-invasive Chirurgie ihren Einfluss zunehmend auch in der Kinderurologie aus: Laparoskopische Operationen des Hodenhochstandes und Nephrektomien (laparoskopisch oder retroperitoneoskopisch) sind nicht nur akzeptierte Alternativen zu den konventionellen Operationsverfahren, sondern haben sich zum „Goldstandard“ entwickelt. Technisch aufwändigere bzw. rekonstruktive Verfahren wie die Pyeloplastik, Heminephrektomie und Adrenalektomie werden in zunehmend großen Serien publiziert und zeigen bei kürzerem Krankenhausaufenthalt vergleichbare Operationszeiten und Raten an Komplikationen. Initiale Erfahrungen mit der laparoskopischen Ureterneuimplantation und der rekonstruktiven Blasenchirurgie sind vielversprechend. Es bedarf allerdings weiterer kontrollierter, randomisierter Studien, um die tatsächliche Überlegenheit laparoskopischer Verfahren zu beweisen.

Summary

Minimal invasive surgery has been established for many ablative and reconstructive procedures in paediatric surgery. In comparison with their open counterparts they are equally efficient, but carry less risks and improved cosmesis. Now this trend continues in paediatric urology: Laparoscopic management of undescended testis as well as minimal invasive nephrectomies are considered gold standard. Technically more advanced techniques like pyeloplasty, heminephrectomy or adrenalectomies are being advocated in several studies, which reveal shorter hospital stay, similar operating time and rate of complications. Initial experiences with laparoscopic ureteric reimplantation and reconstructive bladder surgery seem promising. However randomized controlled studies are necessary to investigate, whether minimal invasive surgery is definitely superior to a conventional approach.

Schlüsselwörter

Kinderurologie - minimal-invasive Chirurgie - Pyeloplastik - Ureterneuimplantation

Keywords

Paediatric urology - minimal invasive surgery - pyeloplasty - ureteric reimplantation

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