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Roboterassistierte Chirurgie – Fortschritt oder teures Spielzeug?

Matched-Pair-Vergleichsanalyse der roboterassistierten Cholezystektomie vs. der laparoskopischen Cholezystektomie

Robot-assisted surgery – Progress or expensive toy?

Matched-pair comparative analysis of robot-assisted cholecystectomy vs. laparoscopic cholecystectomy

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Zusammenfassung

Ziel und Methode

Durch einen Matched-Pair-Vergleich zwischen der laparoskopischen Cholezystektomie (LC) und der roboterassistierten laparoskopischen Cholezystektomie (RAC) sollten durch eine Analyse die Wertigkeiten beider Methoden und deren Vor- und Nachteile herausgearbeitet werden. Die Betrachtung erfolgte durch Auswertung der postoperativen Ergebnisse, einer Kostenanalyse und der subjektiven Befragung der Patienten. So entstanden aus den 35 konsekutiven RAC retrospektiv 35 Parallelstichproben.

Ergebnisse

Bei den postoperativen Ergebnissen gab es keine signifikanten Unterschiede zwischen der LC und RAC.

In der subjektiven Einschätzung der Patienten gab es ebenfalls keine signifikanten Unterschiede, aber die RAC wurde marginal schlechter bewertet. Einen entscheidenden Unterschied gab es in der Kostenanalyse zum Zeitpunkt der Leistungserbringung.

Schlussfolgerungen

Die alleinige Operation der RAC ist mit Wartungskosten und Anschaffungskosten deutlich teurer und lässt sich zu diesem Zeitpunkt im jetzt geltenden DRG-System nicht kostendeckend abbilden.

Die postulierten Vorteile dabei sind das präzise Arbeiten auf engstem Raum, ergonomisch günstige Voraussetzungen für den Chirurgen. Grundvoraussetzungen dafür sind die Kontrolle der Kosten und deren vernünftige Abbildung im geltenden Entgeltsystem.

Abstract

Aim and methods

By means of a matched-pair analysis comparing data obtained from laparoscopic cholecystectomy (LC) and robot-assisted laparoscopic cholecystectomy (RAC), the value of both methods as well as the advantages and disadvantages of both approaches were elucidated. The consideration was carried out by evaluation of postoperative surgical results, a cost analysis and a subjective survey of the patients using a questionnaire. Thus, from the 35 consecutive RAC, 35 (parallel) retrospectively matched pairs were established.

Results

Postoperative surgical results did not show any significant differences between LC and RAC. In the individual assessment by each patient, there were also no significant differences; however, there was a tendency towards the assessment of the RAC to be slightly worse. A striking difference was found with respect to the cost analysis at the time of surgery.

Conclusion

The RAC operation alone is significantly more expensive compared to LC with respect to maintenance and acquisition costs. In addition, RAC can at present not be completely reimbursed under the current German diagnosis-related system. The postulated advantages of RAC comprise mainly the precise preparation within narrow confinements and the favorable ergonomic handling for the surgeon. The basic prerequisites are control of the costs and a reasonable reflection in the current reimbursement system.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Minimal-invasive Chirurgie, HELIOS Klinikum Aue, Gartenstr. 6, 08280, Aue, Deutschland

    R. Albrecht

  2. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, ELBLANDKLINIKEN Riesa, Riesa, Deutschland

    D. Haase & R. Zippel

  3. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland

    U. Settmacher

  4. Klinik für Psychiatrie und Psychotherapie, Heinrich Braun Krankenhaus Zwickau, Zwickau, Deutschland

    H. Koch

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  1. R. Albrecht
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  2. D. Haase
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  3. R. Zippel
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  4. H. Koch
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Correspondence to R. Albrecht.

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Interessenkonflikt

R. Albrecht, D. Haase, R. Zippel, H. Koch und U. Settmacher geben an, dass kein Interessenkonflikt besteht.

Bei diesem Beitrag handelt es sich um eine retrospektive Studie ohne Einfluss auf die Behandlung.

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Albrecht, R., Haase, D., Zippel, R. et al. Roboterassistierte Chirurgie – Fortschritt oder teures Spielzeug?. Chirurg 88, 1040–1045 (2017). https://doi.org/10.1007/s00104-017-0466-4

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