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Radikale retropubische „Fast-track-Prostatektomie“

Erste Erfahrungen mit einem interdisziplinären, multimodalen Behandlungskonzept zur Beschleunigung der postoperativen Rehabilitation

Fast-track surgery in radical retropubic prostatectomy

First experiences with a comprehensive program to enhance postoperative convalescence

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Zusammenfassung

Die „Fast-track-Chirurgie“ ist eine Kombination verschiedener prä-, peri- und postoperativer Behandlungskonzepte bei elektiven Eingriffen, die die postoperative Rekonvaleszenz deutlich zu verkürzen scheint und die Quote der allgemeinen postoperativen Komplikationen senken kann. Obwohl die Vorteile dieses Konzeptes in prospektiven, randomisierten Studien für darmchirurgische Eingriffe überprüft sind, kann die „Fast-track-Chirurgie“ prinzipiell bei fast allen operativen Eingriffen eingesetzt werden. Die eigenen Erfahrungen zeigen, dass die „Fast-track-Chirurgie“ weitgehend auf die retropubische radikale Prostatektomie umsetzbar erscheint. Eine kritische Überprüfung der „Fast-track-Chirurgie“ in ihrer Übertragbarkeit auf die radikale Prostatektomie oder andere größere Eingriffe in der Urologie in randomisierten, kontrollierten Studien ist allerdings notwendig.

Abstract

Fast-track surgery is a comprehensive program for the optimization of perioperative care in elective surgery reducing potential postoperative complications and speeding up convalescence. Recent data from randomized colon resection trials emphasize that fast-track surgery is possible in most major operations. Our initial results in radical retropubic prostatectomy fast-track surgery have been encouraging. Fast-track surgery in major urological operations needs validation using randomized trials.

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Literatur

  1. Anderson AD, McNaught CE, MacFie J et al. (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90: 1497–1504

    Article  PubMed  Google Scholar 

  2. Apfel CC, Korttila K, Abdalla M et al. (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350: 2441–2451

    Article  PubMed  Google Scholar 

  3. Augustin H, Hammerer P, Graefen M et al. (2003) Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 43: 113–118

    Article  PubMed  Google Scholar 

  4. Brandstrup B, Tonnesen H, Beier-Holgersen R et al. (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238: 641–648

    Article  PubMed  Google Scholar 

  5. Cheatham ML, Chapman WC, Key SP, Sawyers JL (1995) A meta-analysis of selective vs. routine nasogastric decompression after elective laparotomy. Ann Surg 221: 469–476

    PubMed  Google Scholar 

  6. Dominguez-Fernandez E, Post S (2003) Abdominal drainages. Chirurg 74: 91–98

    Article  PubMed  Google Scholar 

  7. Firoozfard B, Christensen T, Kristensen JK et al. (2003) Fast-track open transperitoneal nephrectomy. Scand J Urol Nephrol 37: 305–308

    Article  PubMed  Google Scholar 

  8. Gottschalk A, Burmeister MA, Radtke P et al. (2003) Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth Analg 97: 1086–1091

    Article  PubMed  Google Scholar 

  9. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78: 606–617

    PubMed  Google Scholar 

  10. Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86: 227–230

    Article  PubMed  Google Scholar 

  11. Knight MK, DiMarco DS, Myers RP et al. (2002) Subjective and objective comparison of critical care pathways for open donor nephrectomy. J Urol 167: 2368–2371

    Article  PubMed  Google Scholar 

  12. Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334: 1209–1215

    Article  PubMed  Google Scholar 

  13. Savoie M, Soloway MS, Kim SS, Manoharan M (2003) A pelvic drain may be avoided after radical retropubic prostatectomy. J Urol 170: 112–114

    Article  PubMed  Google Scholar 

  14. Schostak M, Matischak K, Muller M et al. (2005) New perioperative management reduces bleeding in radical retropubic prostatectomy. BJU Int 96: 316–319

    Article  PubMed  Google Scholar 

  15. Schwenk W, Muller JM (2005) What is „Fast-track“-surgery? Dtsch Med Wochenschr 130: 536–540

    Article  PubMed  Google Scholar 

  16. Schwenk W, Raue W, Haase O et al. (2004) „Fast-track“ colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery. Chirurg 75: 508–514

    PubMed  Google Scholar 

  17. Slim K, Vicaut E, Panis Y, Chipponi J (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91: 1125–1130

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf

    H. Heinzer, R. Heuer, O. v. Nordenflycht, C. Eichelberg & H. Huland

  2. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf

    P. Friederich & A. E. Goetz

  3. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    H. Heinzer

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  1. H. Heinzer
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  2. R. Heuer
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  3. O. v. Nordenflycht
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  4. C. Eichelberg
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  5. P. Friederich
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  6. A. E. Goetz
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  7. H. Huland
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Correspondence to H. Heinzer.

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Heinzer, H., Heuer, R., v. Nordenflycht, O. et al. Radikale retropubische „Fast-track-Prostatektomie“. Urologe 44, 1287–1294 (2005). https://doi.org/10.1007/s00120-005-0923-4

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  • DOI: https://doi.org/10.1007/s00120-005-0923-4

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