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Roboterunterstützte hepatobiliäre Chirurgie und Magenchirurgie

Robotic hepatobiliary and gastric surgery

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Zusammenfassung

Die hepatobiliäre Chirurgie erfordert zu ihrer sicheren Durchführung ein spezielles, mehrjähriges Training und setzt ein adäquates, d. h. hohes Maß an Erfahrung für den Chirurgen voraus. Vor diesem Hintergrund fand die minimal-invasive hepatobiliäre Chirurgie in der Vergangenheit im Vergleich mit anderen laparoskopischen Verfahren im Viszeraltrakt eine eher geringe Akzeptanz. So werden minimal-invasive Resektionsverfahren von der Mehrheit der hepatobiliären Chirurgen heute weiterhin zurückhaltend eingesetzt.

Zu der weit verbreitet durchgeführten Magenchirurgie existiert inzwischen ein umfangreiches Publikationsspektrum zur Frage des konventionellen vs. laparoskopischen Vorgehens, ohne jedoch Erfahrungen zu roboterunterstützten Verfahren insbesondere bei onkologischer Indikation bislang mit einzubeziehen.

Die jüngeren Entwicklungen bei der roboterunterstützten Plattform ermöglichen es, die zahlreichen Einschränkungen der auf laparoskopischem Wege durchgeführten hepatobiliären Chirurgie zunehmend zu überwinden. Eine gesteigerte Fertigkeit durch präzisere endoskopische Gelenkbewegungen, verfeinerte Software-abgestimmte Bewegungen des Operateurs und ein hochauflösendes dreidimensionales Blickfeld durch stereotaktische Kamerabilder ermöglichen dem Chirurgen eine sichere und sorgfältige Dissektion der Leberhilusstrukturen und zügige endoskopische Nahtmöglichkeiten im Falle intraoperativer Blutungen. Diese Vorteile führten in vielen Zentren zur Ausweitung des Indikationsspektrums minimal-invasiver Chirurgie in der hepatobiliären Chirurgie und auch in der Magenchirurgie mit mittlerweile ermutigenden Zwischenergebnissen. Als Anwender roboterunterstützter Verfahren mit den bislang größten Eingriffszahlen wird im Folgenden ein Überblick über den neuesten Stand dieser Technik in der hepatobiliären Chirurgie und Magenchirurgie gegeben.

Abstract

Hepatobiliary surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive hepatobiliary surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant about the approach. On the other hand, gastric surgery is a very popular field of surgery with an extensive amount of literature especially regarding open and laparoscopic surgery but not much about the robotic approach especially for oncological disease. Recent development of the robotic platform has provided a tool able to overcome many of the limitations of conventional laparoscopic hepatobiliary surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon’s movements, and high-definition three-dimensional vision provided by the stereoscopic camera, allow for steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive hepatobiliary and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted hepatobiliary and gastric surgery.

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Interessenkonflikt. L. Milone, A. Coratti, D. Daskalaki, E. Fernandes und P.C. Giulianotti geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Department of Surgery, Division of Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood MC 958 Room 435 E, 60612, Chicago, IL, USA

    L. Milone, A. Coratti, D. Daskalaki, E. Fernandes & P.C. Giulianotti MD

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  1. L. Milone
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  2. A. Coratti
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  3. D. Daskalaki
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  4. E. Fernandes
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  5. P.C. Giulianotti MD
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Correspondence to P.C. Giulianotti MD.

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Übersetzt ins Deutsche von Prof. Dr. Martin Gasser, Chirurgische Universitätsklinik Würzburg.

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Milone, L., Coratti, A., Daskalaki, D. et al. Roboterunterstützte hepatobiliäre Chirurgie und Magenchirurgie. Chirurg 84, 651–664 (2013). https://doi.org/10.1007/s00104-013-2581-1

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