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Vorteile und Entwicklungspotenziale der laparoskopischen Leberchirurgie

Advantages and future perspectives of laparoscopic liver surgery

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Zusammenfassung

Hintergrund

Die laparoskopische Leberchirurgie (LLC) wird weltweit zunehmend eingesetzt, da sie einige potenzielle Vorteile gegenüber der offenen Chirurgie bietet.

Ziel der Arbeit

Zentrale Vor- und Nachteile der LLC im Vergleich zur offenen Chirurgie werden dargestellt.

Material und Methoden

Klinisch relevante Faktoren der minimal-invasiven im Vergleich zur offenen Leberchirurgie in der aktuellen Literatur werden analysiert.

Ergebnisse

Neben kosmetischen Vorteilen zeigt die aktuelle Literatur Vorteile in der Krankenhausverweildauer und der Lebensqualität für die LLC auf. Im Gegensatz zu Major-Resektionen können parenchymsparende Resektionen durch den meist kürzeren postoperativen Krankenhausaufenthalt häufig kostenneutral erfolgen, wobei für die LLC neben personellen auch entsprechende technische Voraussetzungen gegeben sein sollten. Zu diesen zählt die intraoperative Sonographie, die auch kontrastmittelverstärkt durchgeführt und mit präoperativer Bildgebung fusioniert werden kann. Zur Verbesserung der anatomischen Orientierung der LLC wird in aktuellen Studien die präoperative Bildgebung in Virtual-Reality-Technik dargestellt oder dreidimensional gedruckt.

Diskussion

Aktuell zeigen sich signifikante Vorteile für die LLC, sodass dieses Verfahren auch in Deutschland eine breitere Anwendung finden sollte.

Abstract

Background

Laparoscopic liver surgery (LLS) is increasingly utilized worldwide due to several potential advantages over open liver surgery.

Objective

Analysis and presentation of the advantages and disadvantages of LLS in comparison to open surgery.

Material and methods

Analysis of clinically relevant factors of minimally invasive liver surgery in comparison to open liver surgery in the current literature.

Results

In addition to obvious cosmetic advantages, the current literature shows advantages regarding length of hospital stay and quality of life after LLC. In contrast to major liver resections, parenchyma-preserving resections often appear cost-neutral due a shorter postoperative hospital stay compared to conventional liver resections. In addition to particular personnel requirements, LLS also has technical prerequisites, such as a dedicated intraoperative ultrasound system. Furthermore, contrast-enhanced laparoscopic examinations are possible and ultrasound information can be fused with preoperative imaging. Virtual reality technology and 3‑dimensional printing are currently under investigation to improve the intraoperative anatomical orientation of LLS.

Conclusion

The current literature reveals significant advantages for LLS so that this procedure should be further developed in Germany in order to offer this technique to as many patients as possible.

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Author information

Authors and Affiliations

  1. Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    Stefan Heinrich, Florian Corvinus, Verena Tripke, Tobias Huber, Florentine Hüttl, Lea Penzkofer, Jens Mittler &  Hauke Lang

  2. Klinik u. Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    Daniel Seehofer

  3. Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero Multispecialistico, Brescia, Italien

    Mohammad Abu Hilal

Authors
  1. Stefan Heinrich
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  2. Daniel Seehofer
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  3. Florian Corvinus
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  4. Verena Tripke
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  5. Tobias Huber
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  8. Jens Mittler
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  9. Mohammad Abu Hilal
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  10. Hauke Lang
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Corresponding author

Correspondence to Hauke Lang.

Ethics declarations

Interessenkonflikt

S. Heinrich, D. Seehofer, F. Corvinus, V. Tripke, L. Penzkofer, J. Mittler, M. Abu Hilal und H. Lang geben an, dass kein Interessenkonflikt besteht. T. Huber wird durch das Bundesministerium für Bildung und Forschung für virtuelle und augmentierte Systeme in der chirurgischen Aus- und Weiterbildung gefördert (BMBF: 16SV8057 „AVATAR“). F. Hüttl erhält eine inneruniversitäre Forschungsförderung der Universitätsmedizin Mainz für 3‑D Drucke in der Leberchirurgie.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Heinrich, S., Seehofer, D., Corvinus, F. et al. Vorteile und Entwicklungspotenziale der laparoskopischen Leberchirurgie. Chirurg 92, 542–549 (2021). https://doi.org/10.1007/s00104-020-01288-3

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  • DOI: https://doi.org/10.1007/s00104-020-01288-3

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