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Evidenz der Roboter-Chirurgie in der onkologischen Viszeralchirurgie

Evidence for robotic surgery in oncological visceral surgery

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Zusammenfassung

Die Überlegenheit minimal-invasiver Operationsmethoden gegenüber der offenen Chirurgie in Bezug auf verschiedene Parameter des Kurzzeitoutcomes mit adäquaten onkologischen Langzeitergebnissen wurde bereits bei vielen Tumorentitäten in hochqualitativen Studien belegt. Die immer weiter verbreitete Roboter-Chirurgie bietet in der minimal-invasiven onkologischen Viszeralchirurgie einige zusätzliche Vorteile, wie die hochauflösende dreidimensionale, stabile Sicht, vollständige Bewegungsfreiheit im Situs, Filterung des natürlichen Tremors und bessere Ergonomie. Dieser Artikel evaluiert nach Kriterien der evidenzbasierten Medizin, ob sich diese postulierten Vorteile in einer Verbesserung der kurzfristigen perioperativen und langfristigen onkologischen Ergebnisse gegenüber der herkömmlichen minimal-invasiven Chirurgie in der onkologischen Viszeralchirurgie (Rektum, Kolon, Magen, Ösophagus, Pankreas, Leber) niederschlagen. Mit Ausnahme der kolorektalen Chirurgie liegen in der onkologischen Viszeralchirurgie derzeit keine randomisiert-kontrollierten Studien (RCTs) zum Vergleich der robotischen mit der laparoskopischen Chirurgie bei viszeralonkologischen Krankheitsbildern vor. Es zeigt sich eine deutliche Diskrepanz zwischen der exponentiell zunehmenden Verbreitung des Operationsroboters und der noch unzureichenden Datenlage. Weitere RCTs sind insbesondere vor dem Hintergrund des großen technologischen Entwicklungspotenzials der robotischen Chirurgie dringend geboten.

Abstract

The superiority of minimally invasive operative methods compared to open surgery with respect to various parameters of short-term outcome with adequate oncological long-term results has already been confirmed for many tumor entities in high-quality studies. The continuously expanding robotic surgery offers certain additional benefits in minimally invasive oncological visceral surgery, such as a high-resolution stable 3‑dimensional view, optimal freedom of movement in situ, elimination of natural tremor and better ergonomics. This article evaluates whether these postulated advantages are reflected in an improvement of the short-term perioperative and long-term oncological results compared to conventional minimally invasive surgery in oncological visceral surgery (rectum, colon, stomach, esophagus, pancreas, liver) according to the criteria of evidence-based medicine. With the exception of colorectal surgery, there are currently no randomized controlled studies comparing robotic to laparoscopic surgery in oncological visceral surgery. There is still a clear imbalance between the exponentially expanding application of robotic surgery and the existing lack of high-quality evidence. Further randomized controlled clinical trials urgently need to be performed especially considering the great technological development potential of robotic surgery.

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    J. Kirchberg & J. Weitz

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Correspondence to J. Kirchberg.

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Interessenkonflikt

J. Weitz gibt Forschungsunterstützung durch Intuitive Surgical an. J. Kirchberg gibt Forschungsunterstützung durch Intuitive Surgical an.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kirchberg, J., Weitz, J. Evidenz der Roboter-Chirurgie in der onkologischen Viszeralchirurgie. Chirurg 90, 379–386 (2019). https://doi.org/10.1007/s00104-019-0812-9

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