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„Natural orifice transluminal endoscopic surgery“ in Deutschland

Daten aus dem deutschen NOTES-Register

Natural orifice transluminal endoscopic surgery in Germany

Data from the German NOTES registry

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Zusammenfassung

Hintergrund

Das deutsche NOTES-Register wird von der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie e. V. (DGAV) seit 2008 als strukturierte Datenerfassung für die „natural orifice transluminal endoscopic surgery“ (NOTES) zur Verfügung gestellt.

Ziel der Arbeit

Im Rahmen der vorliegenden Arbeit sollten die Gesamtdaten des NOTES-Registers nach über 5-jähriger Laufzeit mit mehr als 3000 Eingriffen deskriptiv analysiert werden.

Material und Methode

Das NOTES-Register steht als freiwillige Onlinedatenbank allen deutschsprachigen Kliniken zur Verfügung und erfasst demografische Daten, Therapiedaten, Komplikationen und den postoperativen Verlauf der Patienten. Es wurden alle Patienten des NOTES-Registers von März 2008 bis November 2013 in die Analyse einbezogen.

Ergebnisse

Von insgesamt 3150 Datensätzen waren 2992 (95 %) valide und für die Analyse geeignet. Mit 88,7 % war die hybride transvaginale Cholezystektomie (tvCCE) der häufigste Eingriff, gefolgt von hybriden transvaginalen/transgastrischen Appendektomien (6,1 %) und hybriden transvaginalen/transrektalen Kolonoperationen (5,1 %). Intraoperative Komplikationen traten in 1,6 % der Fälle, postoperative Komplikationen in 3,7 % auf. Die Konversionsrate betrug 1,5 %. Intraoperative Blasenverletzungen und postoperative Harnwegsinfektionen konnten als methodenspezifische Komplikationen von transvaginalen Eingriffen identifiziert werden. Darmverletzungen stellen mit 0,2 % eine seltene, aber potenziell schwerwiegende Komplikation transvaginaler Operationen dar.

Schlussfolgerung

Mit dem NOTES-Register wird die verantwortungsvolle Einführung der neuen Operationstechnik in Deutschland von der chirurgischen Gemeinschaft aktiv begleitet. Aufgrund der hohen Zahl an Eingriffen konnten trotz insgesamt geringer Komplikationsrate erstmals methodenspezifische Komplikationen identifiziert werden. Diese Kenntnisse können die Sicherheit von NOTES in der Praxis weitererhöhen.

Abstract

Background

The German NOTES registry (GNR) was initiated by the German Society for General and Visceral Surgery (DGAV) as a treatment and outcome database for natural orifice transluminal endoscopic surgery (NOTES).

Aim

The aim of this study was the descriptive analysis of all GNR data collected over a 5-year period since its start in 2008 with more than 3000 interventions.

Material and methods

The GNR is an online database with voluntary participation available to all German-speaking clinics. Demographic data, therapy details, complications and data on the postoperative course of patients are recorded. All cases in the GNR between March 2008 and November 2013 were included in the analysis.

Results

From a total of 3150 data sets 2992 (95 %) were valid and suited for the analysis. Hybrid transvaginal cholecystectomy was the most frequently used procedure (88.7 %), followed by hybrid transvaginal/transgastric appendectomy (6.1 %) and hybrid transvaginal/transrectal colon procedures (5.1 %). Intraoperative complications occurred in 1.6 %, postoperative complications in 3.7 % and conversions were reported in 1.5 %. Intraoperative bladder injuries and postoperative urinary tract infections were identified as method-specific complications of transvaginal procedures. Bowel injuries occurred as a rare (0.2 %) but potentially serious complication of transvaginal operations.

Conclusion

The German surgical community ensures a safe and responsible introduction of the new NOTES operation techniques with its active participation in the GNR. Despite an overall low complication rate, the high number of procedures in the GNR permitted the identification of method-specific complications. This knowledge can be used to further increase the safety of NOTES in practice.

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Danksagung

Die folgenden Abteilungen haben 2012 und 2013 ebenfalls aktiv am NOTES-Register teilgenommen: K. Gellert, Sana Klinikum Berlin, Berlin; M.W. Büchler, Universitätsklinik Heidelberg, Heidelberg; L. Schreiber, Hufeland Klinikum Bad Langansalza, Bad Langensalza; J. Bretschneider, Asklepios Klinik Weißenfels, Weißenfels; P. Harding, St. Vinzenz-Hospital, Dinslaken; H.J. Gassel, Evangelisches Krankenhaus Mülheim, Mülheim an der Ruhr; G. Kähler, Chirurgische Universitätsklinik Mannheim, Mannheim; T. Kocher, Kantonsspital Baden, Baden (Schweiz); M. Jugenheimer, Krankenhaus Herrenberg, Herrenberg; U. Pohlen, Klinikum Offenburg, Offenburg; T. Böttger, Euromedclinic Fürth, Fürth; B. Schneider, St. Marien-Hospital, Bonn; K. Kraft, Klinikum Kirchheim-Nürtingen, Nürtingen; T. Simon, Krankenhaus Sinsheim, Sinsheim.

Einhaltung ethischer Richtlinien

Interessenkonflikt. K.S. Lehmann, C. Zornig, G. Arlt, M. Butters, D.R. Bulian, R. Manger, J. Burghardt, N. Runkel, A. Pürschel, J. Köninger und H.J. Buhr geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Chirurgische Klinik I, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Freie- und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    K.S. Lehmann

  2. Chirurgische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland

    C. Zornig

  3. Allgemein-, Viszeral- und minimal-invasive Chirurgie, Park-Klinik Weißensee, Berlin, Deutschland

    G. Arlt

  4. Abteilung für Allgemein-, Viszeral- und minimalinvasive Chirurgie, Krankenhaus Bietigheim, Bietigheim-Bissingen, Deutschland

    M. Butters

  5. Klinik für Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität Witten/Herdecke, Campus Merheim – Kliniken der Stadt Köln gGmbH, Köln, Deutschland

    D.R. Bulian

  6. Allgemein- und Viszeralchirurgie, Minimal invasive Chirurgie, Klinik Schwabmünchen, Schwabmünchen, Deutschland

    R. Manger

  7. Abteilung für Allgemeine Chirurgie, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland

    J. Burghardt

  8. Klinik für Allgemein- und Viszeralchirurgie, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Deutschland

    N. Runkel

  9. Allgemein- und Viszeralchirurgie, Petrus-Krankenhaus, Wuppertal, Deutschland

    A. Pürschel

  10. Klinik für Allgemein- und Viszeralchirurgie, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Deutschland

    J. Köninger

  11. Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V., Haus der Bundespressekonferenz, Berlin, Deutschland

    H.J. Buhr

Authors
  1. K.S. Lehmann
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  2. C. Zornig
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  3. G. Arlt
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  4. M. Butters
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  5. D.R. Bulian
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  6. R. Manger
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  7. J. Burghardt
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  8. N. Runkel
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  9. A. Pürschel
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  10. J. Köninger
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  11. H.J. Buhr
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Corresponding author

Correspondence to K.S. Lehmann.

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Lehmann, K., Zornig, C., Arlt, G. et al. „Natural orifice transluminal endoscopic surgery“ in Deutschland. Chirurg 86, 577–586 (2015). https://doi.org/10.1007/s00104-014-2808-9

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  • DOI: https://doi.org/10.1007/s00104-014-2808-9

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