Laparoskopische lymphonodektomie. Aspekte zur technik, didaktik und ergebnisse

Laparoscopic lymph-node dissection is an attractive technique for the staging of pelvic tumors. Applications in gynaecological oncology include surgical therapy of cancers of the endometrium, cervix and vagina, and early-stage ovarian cancers. Meanwhile studies with large case series have been published and have shown that laparoscopic pelvic and paraaortal lymph-node dissection is at least equivalent to the open procedure in terms of radicality. Advantages over the open technique are reduced intraoperative blood loss, shorter hospital stay, and a reduction in postoperative pain. General dissemination has been hampered by the lack of availability of necessary equipment, the reportedly flat learning curve, and the challenging teaching process for this demanding technique. Modern multimodal and multimedia teaching techniques such as video demonstrations of the pelvic anatomy, phantom and cadaver courses, and visits to centres with the appropriate expertise are promising ways to provide access to the technique in clinical practice and to increase the number of centres offering this procedure to their patients.