(Deutsch) Nerverhalt bei Prostatektomie – kleine Clips mit großer Wirkung?

Sorry, this entry is only available in German.

Fachartikel von Dr. med. Mustapha Addali: “Roboterassistierte radikale Zystektomie mit intrakorporaler Harnableitung”

“Roboterassistierte radikale Zystektomie mit intrakorporaler Harnableitung
– Operationstechnik und Modell zur Etablierung”

 

Zum Artikel Urologen.info, Heft 4/ September 2015   >>> Artikel Dr. Addali

 

Results

We ask our patients about their state of health in regular intervals for ten years after their surgery, so we have a good overview of the oncological and functional results of our therapies. Since 2006 nearly 4800 men have undergone in prostate cancer surgery in Gronau. These data are collected and analyzed in a data bank which is especially programmed for us. As a co-founder of German Society for Robot-Assisted Urology (DGRU, www.dgru.de) we have made this data bank available for all those clinics, which are working with the da Vinci surgical robot.

Here you can see a summary of the results.  For more information, please feel free to contact the Study Secretariat.

Download results.

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Operation with da Vinci

How it works.

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The PZNW

Welcome to the PZNW! Here’s something about it’s history.

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Recent studies

In the following is an overview of our currently running studies.

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Course of operation

The removal of the prostate with the da Vinci-System takes approximately 2 to 3 hours.  Usually the pure operating time is under 90 minutes.

Clear case for qualified surgeons

Before the actual surgery, the da Vinci-System and the patient should be prepared. After the narcosis we generally make 6 small incisions on the abdominal wall, and later the instruments will be put in through them, and the prostate will be removed. While the surgical team, which consists of an assistant operator and medical staff, take care of the patient and the system, the operator can concentrate on the surgery from the console. As soon as the instruments are in position, the prostate is vacated. The vascular area -the prostate is located between the bladder and the urethra- is clamped and diverted. Then the tissues, which surround the prostate, are pushed down. If the prostate cancer has not spread beyond the prostate capsule yet, the prostate can be peeled out from the tissues. This protects the erection nerves and the bladder neck so it has a positive effect for the healing of the structure (vessels and tissue) of the anastomosis. If the cancer has already attacked a bigger area, over the prostate capsule, we remove the prostate with the surrounding tissue layers. After the removal of the prostate and the appended seminal vesicle, the urethral stump is sutured to the bladder neck. We place a catheter through the urethra to spare this area for six to ten days. Then on the fifth postoperative day we do a leakage test- if there is no leakage, we remove the catheter on the same day. If you are interested, here you can watch a video of the surgery: http://www.youtube.com/user/Prostatazentrum

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Jobs & Training

Innovative employer in a contemplative environment: the PZNW and Gronau in professional and personal point of view are a good meeting point.

Liveable environment, innovative workplace

Gronau is located 90 km from Osnabrück, 60 km from Münster and situated directly next to the Dutch border. Gronau has approximately 46.000 inhabitants, and it has a nice small river, the Dinkel. Moreover Gildehauser Venn is a tranquil little town in itself. Gronau has become well-known across Europe because of the opening of the rock ’n’ pop museum in 2004. The museum is situated in the Kesselhalle, which was Mathieu van Deldena’s weaving mill before.  That we have chosen this location was not accidental: Udo Lindenberg originates from Gronau; at the end of April, since 1986, the biggest performers of Jazz & Blues have met annually at the Jazz Festival. The Rock Festival ’Auf die Ohren’ attracts the legends of this genre.

In this environment you can live healthy – and work well. The St. Antonius- Hospital Gronau, the Prostate Center Northwest, as well as the European Robotic Institute (ERI) are offering exciting prospects and interesting challenges for this in an innovative environment, and in a motivated team. Of course our training offering is equally attractive.

You need to understand what you are doing

The results of the surgeries made by the da Vinci System are really convincing. They require special training and experience. Therefore the surgeons first should build the necessary skills with the help of the simulations and secure their knowledge before they actually operate. For this purpose we have founded the European Robotic Institute (ERI) in Gronau as a platform of knowledge exchange and transfer. During our trainings and events we exchange our knowledge about minimally invasive and robotic surgery. Nurses, assistants, surgeons and even corporate customers can train and test their skills in the ERI since August 2012, which is equipped with the latest simulation and presentation equipment. The ERI’s offer includes simulations, practical trainings, and online trainings for the pre- and post graduated courses. The training courses are certified, so they offer a high level quality for the participants and they can be charged officially. So, the ERI’s goal is not just the dissemination of the robotic technique, but also to increase the quality of care.

Vacancies

We are always happy to see new faces. Job vacancies can be found on the website of the St. Antonius Hospital in Gronau.

Jobs for physicians

Jobs for nurses

Jobs for technical assistance

Jobs for other professional groups

Training places

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European Robotic Institute

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Treatment

The whole spectrum of the possibilities: in the PZNW we offer all the approved therapies – from radiotherapy, brachytherapy to the minimally invasive robot-assisted surgery with the da Vinci system:

Robot-assisted prostatectomy

Brachytherapy

External beam radiation therapy

HIFU therapy

Hormone therapy

 

Open total prostatectomy

The gold standard is not so shiny

We do not use this procedure in the PZNW. We mention this form of therapy only for completeness. The open prostatectomy is the classic form of the prostate removal, because earlier only this method allowed the surgeon full view and control of the surgery steps. There are two possible ways to access the prostate: either via an incision in the perineum or via the abdomen. Even though this form of intervention is the best studied, we prefer the robot-assisted method. It has many significant advantages: less blood loss, less risk of infection, rare wound healing difficulties, less stress for the patient, shorter healing process. The prognosis of the patients with minimal invasive surgery seems to be better – presumably the operation is performed by an experienced surgeon, in a center with high number of cases.

 

 

 

Minimal invasive total prostatectomy

Protective, but inaccurate

During laparoscopic, minimal invasive total removal of the prostate the surgeon puts in specific instruments through small incisions – inter alia a camera, with which the surgeon can lead the instruments under video control. Contrary to open surgery, this procedure is more sparing for our patients. However, it requires appropriate education, and in comparison to open surgery the costs are higher, and more effort is needed.  Compared to the da Vinci-system, the three- dimensional imagery and the high level of precision are missing.

 

Brachytherapy

Attack from closeness

During brachytherapy from short distance the tumor is radioactive irradiated directly from the body surface, or in the tissue, or in body cavities. We distinguish 2 forms of the internal radiation- one of them is the so-called afterloading, and the other form is the seed implantation. During afterloading the tumor tissue is first ‘quilted’ by guide tubes, hollow tubes, or needles. Through them source of radiation is led into the tumor, and it remains there until the end of the treatment. Afterloading is not only used for the treatment of the prostate cancer, but it is used for example in cancer of the mouth floor, esophageal-, ENT (ear, nose, throat), breast, – and gynecological cancers. In case of prostate cancer, the afterloading – as well as in cases of other cancers- is often combined with external beam radiation. In contrast, the seed implantation uses low-dose radioactive implants which are implanted into the tumor, and the tumor is destroyed from inside.

 

External beam irradiation

Focusing to the radiation field

During the external, so-called ‘percutaneous planned 3D conformal radiation’ the tumor tissue is irradiated from outside, through the skin. In order to protect the surrounding tissue the radiation field is exactly pre-calculated with the help of computed tomography, and then it is irradiated in single doses for a few seconds or minutes. The external beam radiation is made at a long-standing cooperation partner. The irradiation affects the general condition of the patient, and it especially affects the surrounding tissues of the tumor. In case of the prostate the irradiation can lead to the irritation of the rectum, bladder, and the erection vessel bundle.

 

HIFU therapy

With sound against the tumor

HIFU means ‘High-Intensity Focused Ultrasound’. With this minimal invasive treatment method we collect ultrasound waves, and we use this 80-100 °C temperature to destroy the tissues which are affected by the tumor. After millimeter precision computerized planning, under anesthesia an ultrasonic probe is inserted through the rectum. Due to the intensive, but precise irradiation, HIFU therapy is especially appropriate for locally limited prostate cancer. It is also applicable in case of recidiv prostate cancer or in case of advanced tumors. We combine the HIFU therapy with the transurethral resection of the prostate (TUR) to make sure that every diseased tissue is destroyed. In the PZNW we have been applying the HIFU therapy for more than 5 years- but we only apply it in studies, because the guidelines classify the HIFU therapy only as an experimental procedure.

 

Hormontherapy

No healing, but slower growth

The cell division of the prostate tumor usually depends on the hormones – especially on testosterone. The therapeutic use is briefly called ‘hormontherapy’ which consists of hormone withdrawal and the use of counter hormones. They affect in different places, but their goal is common: the slow-down of the tumor growth. Even the complaints alleviate which are caused by the tumor. Nevertheless complete recovery is not possible with the hormone therapy. That is why we use hormone therapy in case of the treatment of advanced prostate cancer, or when other therapeutic options are cannot be used. We treat with tablets or with injections- with its help we place medicament depots under the skin, which have a longtime effect and the intervals of injections are extended. Hormone therapy is not a risky therapy. The typical side effects are hot flashes, sexual disinterest, and infertility. These symptoms can be counteracted by sport.  During a fertility treatment unfortunately for men with prostate cancer this is not a possible tumor therapy method.

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