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Robotisch assistierte Chirurgie des Rektumkarzinoms – Technik, Limitationen und Ergebnisse

Robotic-assisted surgery of rectal cancer—Technique, limitations and results

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Zusammenfassung

Hintergrund

Die Zahl der onkologischen robotisch assistierten Rektumresektionen wächst in Deutschland und weltweit exponentiell. Die Indikation, die Technik und die potenziellen Limitationen dieser Operationstechnik werden unverändert diskutiert.

Material und Methode

Die standardisierte modulare Operationstechnik, die Ergebnisse unserer Klinik und die publizierte Datenlage werden vorgestellt.

Ergebnisse

Die Operation sollte im Sinne der Standardisierung und Ausbildung in 7 Module unterteilt werden. Prinzipielle Limitationen oder Kontraindikationen gibt es nach Durchlaufen der Lernkurve nicht. Die robotisch assistierte Vorgehensweise ist der offen chirurgischen Vorgehenseise in folgenden Punkten überlegen: Blutverlust, Lymphknotenausbeute, negativer zirkumferenzieller Absetzungsrand, Komplikationsrate und Liegezeit. Im Vergleich zur konventionellen Laparoskopie sind Konversionen und postoperative Sexual- und Blasenfunktionsstörungen seltener. Die Operationszeit ist länger.

Schlussfolgerung

Die robotisch assistierte onkologische Rektumresektion ist fest etabliert und standardisiert. Sie ist der offen chirurgischen und konventionell laparoskopischen Vorgehensweise in mehreren wichtigen Aspekten überlegen und ist auf dem Weg zum chirurgischen Standard für diese Erkrankung.

Abstract

Background

The number of oncological robotic-assisted rectal cancer resections is rapidly increasing in Germany and worldwide; however, the indications, technique and potential limitations of this surgical technique are still discussed.

Material and methods

The standardized modular surgical technique, the results in our clinic and the currently published evidence are presented.

Results

The procedure should be divided into seven modules in terms of standardization and teaching. After the learning curve there are principally no limitations or contraindications. The robotic-assisted approach is superior to open surgery in the following points: blood loss, lymph node harvest, negative circumferential resection margin (CRM), complication rate and length of hospital stay. In comparison to conventional laparoscopy the conversion rate and postoperative sexual and bladder function disorders are decreased. The operating time is longer.

Conclusion

Robotic-assisted rectal cancer resection is firmly established and standardized. The technique is superior to open surgery and conventional laparoscopy in some important aspects and is developing into the standard for this disease.

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Authors and Affiliations

  1. Klinik für Visceralchirurgie/Robotic Surgery, Augusta Kliniken Bochum, Bergstraße 26, 44791, Bochum, Deutschland

    Benno Mann, Sebastian Kukies, Olaf Krogh & Gintas Virakas

Authors
  1. Benno Mann
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  2. Sebastian Kukies
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  3. Olaf Krogh
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  4. Gintas Virakas
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Corresponding author

Correspondence to Benno Mann.

Ethics declarations

Interessenkonflikt

S. Kukies und O. Krogh geben an, dass kein Interessenkonflikt besteht. B. Mann und G. Virakas sind als Proctor für die Firma Intuitive Surgical™ tätig und erhalten für diese Tätigkeit ein Beraterhonorar.

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.

Additional information

Redaktion

M. Anthuber, Augsburg

Supplementary Information

Video 1 (Modul 2): Absetzen der Gefäße

Video 2 (Modul 3): Mobilisation von medial

Video 3 (Modul 4): Mobilisation der linken Flexur

Video 4 (Modul 5): Totale mesorektale Exzision

Video 5 (Modul 6): Absetzen des Rektums/Bergung

Video 6 (Modul 7): Anastomose/Wundverschluss

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Mann, B., Kukies, S., Krogh, O. et al. Robotisch assistierte Chirurgie des Rektumkarzinoms – Technik, Limitationen und Ergebnisse. Chirurg 92, 599–604 (2021). https://doi.org/10.1007/s00104-021-01424-7

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  • DOI: https://doi.org/10.1007/s00104-021-01424-7

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