Zusammenfassung
Roboterassistierte Systeme werden seit längerem in einigen operativen Fächern, wie der Urologie, Chirurgie, Orthopädie, Ophthalmologie, Neurochirurgie und auch der Gynäkologie, eingesetzt. Trotz der beschriebenen Vorteile bei bestimmten Eingriffen in der Urologie und Chirurgie gab es bisher nur wenige Indikationen für einen breiten Einsatz in der operativen Gynäkologie. Es liegt bereits eine Anzahl von Beobachtungen und Untersuchungen zu verschiedenen Eingriffen vor, doch systematische Studien, die die roboterassistierte Chirurgie sowohl mit dem offenen Vorgehen als auch mit der klassischen Laparoskopie vergleichen, fehlen. Die roboterassistierte Chirurgie kann die Nachteile der konventionellen Laparoskopie (z. B. zweidimensionale Darstellung, eingeschränkte Beweglichkeit der Instrumente, Einfluss des Operateurs) unter Beibehaltung der Vorteile der minimal-invasiven Chirurgie minimieren. Besonders bei komplexen, lang dauernden Operationen kommen die Vorteile des ermüdungsarmen Operierens bei verbesserter Darstellung des Operationsgebietes zum Tragen. Die Entwicklung roboterassoziierter Operationssysteme mit mobiler Steuereinheit und wieder verwendbaren Instrumenten unter direkter visueller und taktiler Kontrolle des Operateurs wird die operativen Möglichkeiten in Zukunft bestimmen.
Abstract
Computerized-enhanced robotic surgery using the daVinci robotic surgical system has been applied successfully in urology, general surgery, orthopedics, ophthalmology, neurosurgery and gynecology. Despite rapid advances in urology and general surgery, robotic surgery systems have had limited use in gynecologic surgery although interest is increasing. The use of robotic assistance (RA) in laparoscopy has been proposed to overcome the disadvantages and limitations of traditional laparoscopic surgery (2-dimensional images, hand tremors and dexterity limitations) while still benefiting from the advantages of the minimally invasive technique. Robotic surgery has the potential to facilitate surgical procedures by allowing the surgeon to sit comfortably while visualizing the abdominal and pelvic cavity in three dimensions with magnification. The development of robot-assisted operating systems with a mobile control unit and reusable instruments under the direct visual and tactile control of the surgeon will determine the operating options of the future.
Literatur
Advincula AP, Xu X, Goudeau ST et al (2007) Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol 14:698–705
Bocca S, Stadtmauer L, Oehninger S (2007) Uncomplicated full term pregnancy after da Vinci-assisted laparoscopic myomectomy. Reprod Biomed Online 14:246–249
Boggess JF, Gehrig PA, Cantrell L et al (2008) A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 199:357 e351–e357
Brummer TH, Seppala TT, Harkki PS (2008) National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000–2005. Hum Reprod 23:840–845
Chammas MF Jr, Kim FJ, Barbarino A et al (2008) Asymptomatic rectal and bladder endometriosis: a case for robotic-assisted surgery. Can J Urol 15:4097–4100
Dharia Patel SP, Steinkampf MP, Whitten SJ et al (2008) Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 90:1175–1179
Gehrig PA, Cantrell LA, Shafer A et al (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111:41–45
Kho RM, Hilger WS, Hentz JG et al (2007) Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 197:113 e111–e114
Liu C, Perisic D, Samadi D et al (2008) Robotic-assisted laparoscopic partial bladder resection for the treatment of infiltrating endometriosis. J Minim Invasive Gynecol 15:745–748
Magrina JF, Kho RM, Weaver AL et al (2008) Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 109:86–91
Marescaux J, Leroy J, Rubino F et al (2002) Transcontinental robot-assisted remote telesurgery: feasibility and potential applications. Ann Surg 235:487–492
Mavrich Villavicencio H, Esquena S, Palou Redorta J et al (2007) Robotic radical prostatectomy: overview of our learning curve. Actas Urol Esp 31:587–592
Meinhold-Heerlein I, Maass N, Bauerschlag D et al (2010) Endoskopie in der gynäkologischen Onkologie. Gynäkologe 43:441–444
Mettler L, Ahmed-Ebbiary N, Schollmeyer T (2005) Laparoscopic hysterectomy: challenges and limitations. Minim Invasive Ther Allied Technol 14:145–159
Mettler L, Ibrahim M, Jonat W (1998) One year of experience working with the aid of a robotic assistant (the voice-controlled optic holder AESOP) in gynaecological endoscopic surgery. Hum Reprod 13:2748–2750
Mettler L, Schollmeyer T, Boggess J et al (2008) Robotic assistance in gynecological oncology. Curr Opin Oncol 20:581–589
Nezhat C, Lavie O, Hsu S et al (2009) Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy–a retrospective matched control study. Fertil Steril 91:556–559
Oleszczuk A, Kohler C, Paulick J et al (2009) Vaginal robot-assisted radical hysterectomy (VRARH) after laparoscopic staging: feasibility and operative results. Int J Med Robot 5:38–44
Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291
Reynolds RK, Advincula AP (2006) Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 191:555–560
Schollmeyer T, Soyinka AS, Schollmeyer M et al (2007) Georg Kelling (1866–1945): the root of modern day minimal invasive surgery. A forgotten legend? Arch Gynecol Obstet 276:505–509
Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64
Whiteside JL (2008) Robotic gynecologic surgery: a brave new world? Obstet Gynecol 112:1198–1200
Narula VK et al (2007) A computerized analysis of robotic versus laparoscopic task performance. Surg Endosc 21:2258–2261; DOI: 10.1007/s00464–007–9363–0
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schollmeyer, T., Mettler, L., Jonat, W. et al. Roboterchirurgie in der Gynäkologie. Gynäkologe 44, 196–201 (2011). https://doi.org/10.1007/s00129-010-2709-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00129-010-2709-z