3.3. Обучение технике лапароскопической простатэктомии

Успех в освоении лапароскопической простатэктомии, главным образом, стал возможен благодаря внедрению программ обучения [18,24,100,101], использующих несколько обучающих модулей, которые включают:

Практические курсы

Курсы на трупном материале

Живые демонстрации

Клиническое обучение

Преподаватель и наставник

Самый важный шаг — это клиническое обучение в операционной комнате с пошаговым изучением всех процедур, начинающееся с ассистенции вторым помощником и заканчивающееся полным управлением операцией, в результате которого специалист получает опыт лапароскопии [24]. Все ведущие центры в Европе установили такие программы обучения для собственного сотрудников, а так же для внешних стажеров (в соответствии с европейской программой обучения). Подобные программы оказались бы очень полезными для клинического обучения ТУР и эндоскопическим технологиям.

Передача изображения на мониторе позволяет операционной бригаде оценить уникальные анатомические особенности каждого индивидуального случая. Поэтому, даже второй ассистент полностью знает обо всех анатомических деталях и каждом шаге процедуры, особенностях выполнения операции, что сильно отличает лапароскопию от открытой хирургии, где, часто только хирург использует приборы для увеличения видимости операционного поля (лупы).

С другой стороны, в настоящее время имеется недостаточное количество мест, где можно пройти полный курс лапароскопической простатэктомии. Недавний обзор выявил, что 44 % заинтересованных в обучении европейских урологов отметили низкую доступность подобного обучения [100]. Кроме того, длительные практические программы обучения с трудом доступны для большинства урологов и аспирантов в Соединенных Штатах из-за значительных финансовых и временных затрат. Несмотря на это, в США нет формального лапароскопического учебного плана обучения резидентов в урологии для такой трудной в освоении методики.

3.4. Преимущества и перспективы лапароскопической радикальной простатэктомии

Только после семи лет оценки лапароскопической простатэктомии онкологические и функциональные результаты кажутся многообещающими и приближаются к таковым при открытой хирургии. Время операции остается все еще более длительным, чем при традиционной позадилонной простатэктомии, но многие центры, успешно занимающиеся лапароскопией, сообщают о времени лапароскопической операции, приближающейся к открытой.

Однако, есть отличные преимущества лапароскопической радикальной простатэктомии, связанные с менее агрессивным подходом:

Меньшая послеоперационная боль

Более низкий процент осложнений

Более короткий период выздоровления

Лучший косметический эффект

Это, прежде всего, связано не с лучшей техникой, а с меньшей интраоперационной травмой. Несмотря на такие результаты, Fornara [68] не обнаружил в острой стадии никакого различия между пациентами, перенесшими лапароскопическую и позадилонную простатэктомии в серологических параметрах (C-реактивный белок, интерлeйкин-6).

Дальнейший потенциал развития лапароскопической радикальной простатэктомии связан с видеоэндоскопией, обеспечивающей оптимальную визуализацию околопростатической анатомии. Это может вести к сохранению структур вокруг сфинктера (добавочная промежностная артерия), улучшить диссекцию апекса, максимально сохранить сосудисто-нервный пучок [102,103]. Кроме того, видео-обучение улучшит передачу анатомических знаний и технического ноу-хау. Однако, все это должно подтверждаться долговременными клиническими исследованиями.

Список литературы

 [1] Clayman R, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278-82.

[2] Coptcoat MJ, Wickham JEA. Laparoscopy in Urology. Min Inv Ther 1992;1:337-41.

[3] Rassweiler J, Henkel TO, Potempa DM, Coptcoat M, Alken P. The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy, and nephroureterectomy. Eur Urol 1993;23:425-8.

[4] Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G. Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol 1999;36:14-20.

[5] Schuessler WW, Kavoussi LR, Clayman RV, Vancaille TH. Laparoscopic radical prostatectomy: Initial case report [abstract 130]. J Urol 1992;147:246A.

[6] Schuessler W, Schulman P, Clayman R, Kavoussi L. Laparoscopic radical prostatectomy: Initial short-term experience. Urology 1997;50:854-7.

[7] Gaston R. personal communication.

[8] Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: The Montsouris experience. J Urol 2000;163: 418-22.

[9] Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK, et al. Laparoscopic radical prostatectomy: preliminary results. Eur Urol 2000;37:615-20.

[10] Bollens R, Vanden Bossche M, Rhoumeguere Th, Damoun A, Ekane S, Hoffmann P, et al. Extraperitoneal laparoscopic radical prostatectomy: results after 50 cases. Eur Urol 2001;40:65-9.

[11] Rassweiler J, Sentker L, Seemann O, Hatziger M, Stock C, Frede T. Heilbronn laparoscopic radical prostatectomy: technique and results after 100 cases. Eur Urol 2001;40: 54-64.

[12] Turk I, Deger IS, Winkelmann B, Roigas J, Schoenberger B, Loening SA. Laparoscopic radical prostatectomy: technical aspects and experience with 125 cases. Eur Urol 2001;40:46-53.

[13] De la Rosette JJMCH, Abbou CC, Rassweiler J, Pilar Laguna M, Schulman CC. Laparoscopic radical prostatectomy: a European virus with global potential. Arch Esp Urol 2002;55:603-9.

[14] Gill I, Zippe C. Laparoscopic radical prostatectomies: Technique. Urol Clin North Am 2001;28:423-8.

[15] Menon M, Shrisvastava A, Tewari A, Sarle R, Hemal A, Peabody JO, et al. Laparoscopic and robot assisted radical prostatectomy: Establishment of a structured program and preliminary analysis of outcomes. J Urol 2002;168: 945-9.

[16] Vogeli TA, Burchardt M, Fornara P, Rassweiler J, Sulser T. Laparoscopic Working Group of the German Urological Association: Current laparoscopic practice patterns in urology: results of a survey among urologiss in Germany and Switzerland. Eur Urol 2002;42:441-6.

[17] Protzel C, Pechoel M, Richter M, Zimmermann U, Klebingat K. Radikale Prostatektomie und pelvine Lymphadenektomie - aktuelle Therapiestrategien in Deutschland - Ergebnisse einer deutschlandweiten Umfrage. Urologe A 2004;43:S59 (abstract P klin 6.5).

[18] Rassweiler J, Stolzenburg J, Sulser T, Deger S, Zumbe J, Hofmockel G, et al. Laparoscopic radical prostatectomy: the experience of the German laparoscopic working group. Eur Urol 2006;49:113-9.

[19] Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris Technique. J Urol 2000;163: 1643-949.

[20] Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt J. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol 2001;160:201-8.

[21] Stolzenburg JU, Do M, Rabenalt R, Pfeiffer H, Horn L, Truss MC, et al. Endoscopic extraperitoneal radical prostatectomy: initial experience after 70 procedures. J Urol 2003;169:2066-71.

[22] Erdogru T, Teber D, Frede T, Marrero R, Hammady A, Seemann O, et al. Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. Eur Urol 2004;46:312-20.

[23] Vallancien G, Abbou CC, Ackermann R, Alken P, Cathelineau X, Fitzpatrick J, et al. New surgical techniques in the treatment of prostate cancer. In: Denis L, Bartsch G, Khoury S, Murai M, Partin A, editors. Prostate Cancer, 3rd International Consultation on Prostate Cancer. Paris: Health Publications; 2003. p. 127-38.

[24] Frede T, Erdogru T, Zukosky D, Gulkesen H, Teber D, Rassweiler J. Comparison of training modalities for performing laparoscopic radical prostatectomy: experience with 1,000 patients. J Urol 2005;174:673-8.

[25] Bollens R, Sandhu S, Roumeguere T, Quackels T, Schulman C. Laparoscopic radical prostatectomy: the learning curve. Curr Opin Urol 2005;15:1-4.

[26] Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbe J, et al. Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. Eur Urol 2005;47:167-75.

[27] Hoznek A, Antiphon P, Borkowski T, Gettman MT, Katz R, Salomon L, et al. Assessment of surgical technique and perioperaitve morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology 2003;61:617-22.

[28] Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallacien G. Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol 2004;171:714-6.

[29] Ruiz L, Salomon L, Hoznek A, Vordos D, Yiou R, de la Taille A, et al. Comparison of early oncologic results of laparoscopic radical prostatectomy by extraperitoneal versus transperitoneal approach. Eur Urol 2004;46:50-6.

[30] Brown JA, Rodin D, Lee B, Dahl DM. Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. Urology 2005;65:320-4.

[31] Remzi M, Klingler HC, Tinzl MV, Fong YK, Lode M, Kiss B, et al. Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy versus open retropubic radical prostatectomy. Eur Urol 2005;48:83-9.

[32] Rassweiler J, Schulze M, Teber D, Seemann O, Frede T. Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol 2004;14:75-82.

[33] Su L-M, Link E, Bhayani SB, Sullivan W, Pavlovich CP. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 2004;64:123- 7.

[34] Walsh PC, Lepor H, Egglestone JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983;4:473-7.

[35] Graefen M, Michl UHG, Heinzer H, Friedrich MG, Eichelberg C, Haese A, et al. Indication, technique and outcome of retropubic nerve-sparing radical prostatectomy. EAU Update Ser 2005;3:77-85.

[36] Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, et al. An operative and anatomic study to help in nerve-sparing during laparoscopic and robotic radical prostatectomy. Eur Urol 2003;43:444-54.

[37] Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128:492-5.

[38] Lepor H, Gregermann M, Crosby R, Mostofi FK, Walsh PC. Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study ofthe adult male pelvis. J Urol 1985;133:207-12.

[39] Gill IS, Ukimura O, Rubinstein M, Finelli A, Moinzadeh A, Singh D, et al. Lateral pedicle control during laparoscopic radical prostatectomy: Refined technique. Urology 2005;65:23-7.

[40] Rassweiler J, Seemann O, Hatziger M, Schulze M, Frede T. Technical evolution of laparoscopic radical parostatectomy after 450 cases. J Endourol 2003;17:143-54.

[41] Rassweiler J, Marrero R, Hammady A, Erdogru T, Teber D, Frede T. Transperitoneal laparoscopic radical prostatectomy: ascending technique. J Endourol 2004;18:593-600.

[42] Myers RP, Goellner JR, Cahill DR. Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection. J Urol 1987;138:543-50.

[43] Ruckle H, Zincke H. Potency-sparing radical retropubic prostatectomy: a simplified anatomical approach. J Urol 1995;153:1875-7.

[44] Lepor H. Practical considerations in radical retropubic prostatecomy. Urol Clin N Am 2003;30:363-8.

[45] Ong AM, Su L-M, Varkarakis I, Inagaki T, Link RE, Bhayani SB, et al. Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol 2004;172:1318-21.

[46] Binder J, Kramer W. Robotically assisted laparoscopic radical prostatectomy. BJU Int 2001;87:408-10.

[47] Abbou CC, Hoznek A, Salomon L, Olsson LE, Lobontiu A, Saint F, et al. Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 2001;165:1964-6.

[48] Rassweiler J, Frede T, Seemann O, Stock C, Sentker L. Telesurgical laparoscopic radical prostatectomy - initial experience. Eur Urol 2001;40:75-83.

[49] Pasticier G, Rietbergen JBW, Guillonneau B, Fromont G, Vallancien G. Robotically assisted laparoscopic radical prostatectomy. Feasibility study in men. Eur Urol 2001;40:70-4.

[50] Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: Initial experience with laparoscopic radical prostatectomy. J Urol 2003;170: 1738-41.

[51] Menon M, Tewari A, Peabody J, Hemal AK, VIP-team. Vattikiti Institute prostatectomy: technique. J Urol 2003;169:2289-92.

[52] Smith Jr JA. Robotically assisted laparoscopic prostatectomy: an assessment of its contemporary role in the surgical management of localized prostate cancer. Am J Surg 2004;188(Suppl):63S-7S.

[53] Cathelineau X, Rozet F, Vallancien G. Robotic radical prostatectomy: the European experience. Urol Clin North Am 2004;31:639-99.

[54] Menon M, Hemal AK, and the VIP team. Vattikuti Institute Prostatectomy: A technique of robotic radical prostatectomy: experience with more than 1000 cases. J Endourol 2004;18:611-9.

[55] Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, et al. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin N Am 2004;31:701-17.

[56] Wolfram M, Brautigam R, Engl T, Bentas W, Heitkamp S, Ostwald I, et al. Robotic-assisted laparoscopic radical prostatectomy. The Frankfurt technique. World J Urol 2003;21:128-32.

[57] Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: The early Frankfurt experience with robotic radical prostatectomy and one year follow up. Eur Urol 2003;44:175-81.

[58] Gettman M, Hoznek A, Salomon L, Katz R, Borkowski T, Antiphon P, et al. Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system. J Urol 2003;170:416-8.

[59] Rassweiler J, Binder J, Frede T. Robotic and telesurgery: will they change our future. Curr Opinion in Urology 2001;11:309-20.

[60] Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 2002;167:51-6.

[61] Salomon L, Levrel O, de la Taille A, Anastasiadis AG, Saint F, Zaki S, et al. Radical prostatectomy by retropubic, perineal and laparoscopic approach: 12 years of experience in one center. Eur Urol 2002;42:104-11.

[62] Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology 2003;62:292-7.

[63] Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol 2003;169:1689-93.

[64] Bhayani SB, Pavlovich CP, Hsu TS, Sullivan W, Su LM. Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology 2003;61:2-6.

[65] Roumeguere T, Bollens R, Bossche MV, Rochet D, Bialek D, Hoffman P, et al. Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol 2003;20:360-6.

[66] Artibani W, Grosso G, Novara G, Pecoraro G, Sidoti O, Sarti A, et al. Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidtiy in two contemporary series in Italy. Eur Urol 2003;44:401-6.

[67] Brown JA, Garlitz C, Gomella LG, Mc Ginnis DE, Diamond SM, Strup SE. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatetcomy. Urol Oncol 2004;22:102-6.

[68] Fornara P, Zacharias M. Minimal invasiveness of laparoscopic radical prostatectomy: reality or dream? Akt Urol 2004;35:395-405.

[69] Keller H, Janetschek G, Abukora F, Leeb K, Schmeller N. Technique of radical prostatectomy - a head to head comparison of retropubic, peineal and laparoscopic access - data on perioperative morbidity. Eur Urol Suppl 2005;4(3):247 (abstract No. 980).

[70] Keller H, Schmeller N, Janetschek G. Urinary continence after retropubic, perineal, and laparoscopic radical prostatectomy: prospective comparfative study. Eur Urol Suppl 2005;4(3):103 (abstract No. 403).

[71] Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbe J, et al. Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. Eur Urol 2005;47:167-75.

[72] Bollens R, Sandhu S, Roumeguere T, Quackels T, Schulman C. Laparoscopic radical prostatectomy: the learning curve. Curr Opin Urol 2005;15:1-4.

[73] Dillioglugi O, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT. Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 1997;157:1760-7.

[74] Sulser T, Guillonneau B, Vallancien G, Gaston R, Piechaud T, Turk I. Complications and initial experience with 1228 laparoscopic radical prostatectomies at 6 European centers. J Urol 2001;165(Suppl):150.

[75] Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, et al. 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 2003;43:113-8.

[76] Omar AM, Townell N. Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques. Prostate Cancer and Prostatic Disease 2004;7:295-301.

[77] Anghel G, Maldonado R, Safi K, Erdogru T, Teber D, Frede T, et al. Laparosocpic radical prostatectomy - comparison of the operative time of different generations of surgeons. Eur Urol Suppl 2005;4(3):244, (abstract No. 968).

[78] Stolzenburg JU, Truss MC, Do M, Rabenalt R, Pfeiffer H, Dunzinger M, et al. Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE)-technical improvements and development of a nerve-sparing, potencypreserving. Approach. World J Urol 2003;22:147-52.

[79] Erdogru T, Teber D, Frede T, Marrero R, Hammady. Rassweiler J. The effect of previous transperitoneal laparoscopic herniorrhaphy on transperitoneal laparoscopic radical prostatectomy. J Urol 2005;173:769-72.

[80] Bhayani SB, Pavlovich CP, Strup SE, Dahl DM, Landman J, Fabrizio MD, et al. Laparoscopic radical prostatectomy: a multi.institutional study of conversion toopen surgery. Urology 2004;63:99-102.

[81] Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM. Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. J Urol 2005;174:135-9, discussion 139.

[82] El-Feel A, Davis JW, Deger S, Roigas J, Wille AH, Schnoor D, et al. Positive margins after laparoscopic radical prostatectomy: A prospective study of 100 cases performed by 4 different surgeons. Eur Urol 2003;43:622-62.

[83] Palisaar R, Noldus J, Graefen M, Ebersdobler A, Haese A, Huland H. Influence of nerve-sparing (NS) procedure during radical prostatectomy on margin status and biochemical failure. Eur Urol 2005;47:176-84.

[84] Guillonneau B, El-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1000 cases at Montsouris Institute. J Urol 2003;169:1261-6.

[85] Rassweiler J, Schulze M, Teber D, Marrero R, Seemann O, Rumpelt J, et al. Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients. J Urol 2005;173:761-4.

[86] Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 2003;61:699-702.

[87] Harris MJ. Radical perineal prostatectomy: Cost efficient, outcome effective, minimally invasive prostate cancer management. Eur Urol 2003;44:303-8.

[88] Noldus J, Michl U, Graefen M, Haese A, Hammerer P, Huland H. Patient-reported sexual function after nervesparing radical retropubic prostatectomy. Eur Urol 2002;42:118-21.

[89] Michl U, Graefen M, Noldus J, Eggert T, Huland H. Fucntional results of various surgical techniques for radical prostatectomy. Urologe A 2003;42:1196-202.

[90] Montorsi F, Padma HN, McCullough A, Brock GB, Broderick G, Ahuja S, et al. Tadalafil in the treatment of erectile dysfunction following bilateral nerve sparing radical prostatectomy: a randomized, double-blind, placebo controlled trial. J Urol 2004;172:1036-41.

[91] Hara I, Kawabata G, Miake H, Nakamura I, Hara S, Okada H, et al. Comparison of quality of life following laparoscopic and open prostatectomy for prostate cancer. J Urol 2003;169:2045-8.

[92] Soderdahl DW, Davis JW, Schellhammer PF, Given RW, Lynch DF, Shaves M, et al. Prospective longitudinal comparative study of health related quality of life in patients undergoing invasive treatments for localized prostate cancer. J Endourol 2005;19:318-26.

[93] Link RE, Su LM, Sullivan W, Bhayani SB, Pavlovich CP. Health realted quality of life before and after laparoscopic radical prostatectomy. J Urol 2005;173:175-9.

[94] Rassweiler J, Hruza M, Teber D, Schulze M, Stock C, Frede T. Quality of life following laparoscopic radical prostatectomy: the Heilbronn experience. Eur Urol Suppl 2005;4(3):246, (abstract No. 973).

[95] Yang BK, Young MD, Calingaert B, Albala DM, Vieweg J, Murphy BC, et al. Prospective and longitudinal patient self-assessed health related quality of life following radical perineal prostatectomy. J Urol 2004;172:264-8.

[96] Salomon L, Saint F, Anastasiadis G, Sebe P, Chopin D, Abbou CC. Combined reporting of cancer control and functional results of radical prostatectomy. Eur Urol 2003;44:656-60.

[97] Link RE, Su LM, Bhayani SB, Pavlovich CP. Making end meet: A cost comparison of laparoscopic and open radical prostatectomy. J Urol 2004;172:269-74.

[98] Lotan Y, Caddedu JA, Gettman MT. The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 2004;172:1431-5.

[99] Herkommer K, Fuchs TA, Hautmann RE, Volkmer BG. Radical prostatectomy for men aged <56 years with prostate cancer. Cost of illness analysis. Urologe A (Suppl):2005. p. 44, (Engl abstract).

[100] Laguna MP, Schreuders LC, Rassweiler JJ, Abbou CC, van Velthoven R, Janetschek G, et al. Development of laparoscopic surgery and training facilities in Europe: Results of a survey of the European Society of Uro-technology (ESUT). Eur Urol 2005;47:346-51.

[101] Teber D, Dekel Y, Frede T, Klein J, Rassweiler J. The Heilbronn laparoscopic training programm for laparoscopic suturing: concept and validation. J Endourol 2005;19:230-8.

[102] Rassweiler J, Safi KC, Subotic D, Teber D, Frede T. Robotic and telesurgery - an update on their prosition in laparoscopic radical prostatectomy. Min Inv Therapy 2005;14: 104-8.

[103] Secin FP, Karanikolas N, Kuroiwa K, Vickers A, Touijer K, Guillonneau B. Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy. Eur Urol 2005;48:786-92.

Для подготовки данной работы были использованы материалы с сайта http://www.uroweb.ru/


Информация о работе «Лапароскопическая робот-ассистированная радикальная простатэктомия. Критический анализ результатов»
Раздел: Медицина, здоровье
Количество знаков с пробелами: 52815
Количество таблиц: 0
Количество изображений: 0

0 комментариев


Наверх