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Robot-assisted laparoscopic cardiomyotomy

Roboterassistierte laparoskopische Cardiomyotomie

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Zusammenfassung

GRUNDLAGEN: Roboterassistierte laparoskopische Eingriffe gewinnen an Popularität. Speziell mikrochirurgische laparoskopische Eingriffe, komplexe Manöver wie intrakorporale händische Anastomosen oder ein kleines, schwerer erreichbares Operationsfeld stellen ideale Indikationen für den Einsatz eines Operationsroboters dar. METHODIK: Universitätsklinik mit reichlicher Erfahrung in Roboterchirurgie. Es wurde die ersten sechs roboterassistierten laparoskopischen Cardiomyotomien an Achalasiepatienten in Österreich durchgeführt. Detaillierte Beschreibung der Operationstechnik, Literaturübersicht und Diskussion. ERGEBNISSE: Die roboterassistierten laparoskopischen Cardiomyotomien stellten für das in Roboterchirurgie und laparoskopischer Myotomie erfahrene Operationsteam keine spezielle Schwierigkeit dar; der postoperative Verlauf der Patienten war komplikationslos. Die Operationszeit betrug 236 min. (220–316) Minuten, davon 38 min. (25–47) für den Aufbau des Roboters. Intra- und postoperativ gab es keine Komplikationen. 6 Monate postoperativ haben 5 von 6 Patienten keine signifikante Dysphagie und keiner Refluxsymptome. Es gibt bereits Fallberichte, kleinere Serien und auch Studien über dieses Thema. Allen gemeinsam ist die positive Beurteilung der Methode. Die Mukosa-Perforationsrate ist signifikant geringer, allerdings müssen höhere Kosten in Kauf genommen werden. Im Rahmen der Lernkurve wird von einer längeren Operationszeit berichtet. DISKUSSION: Trotz insgesamt positiver Bewertung der Methode müssen die doch deutlich höheren Kosten den potenziellen Folgen einer (vielleicht unerkannten) Mukosaperforation gegenübergestellt werden. SCHLUSSFOLGERUNGEN: Die laparoskopische Cardiomyotomie ist die erste laparoskopische "Standardoperation", bei der klinisch ein klarer Vorteil gegenüber der konventionell laparoskopischen Operation herausgearbeitet werden konnte. Im Rahmen der Verfügbarkeit eines solchen Operationsroboters sollte er für die laparoskopische Cardiomyotomie eingesetzt werden.

Summary

INTRODUCTION: Robot-assisted laparoscopic surgery is an expanding field of medicine. In endoscopic microsurgery particularly, difficult maneuvers such as intracorporeal hand-sewn anastomoses or a narrow operating field are ideal indications for use of an operation robot. PATIENTS AND METHODS: Six patients, four men and two women, underwent robot-assisted laparoscopic cardiomyotomy for achalasia at a tertiary referral center with substantial expertise in robotic surgery. A detailed description of the operation technique is provided, together with a review of the literature. RESULTS: Robot-assisted laparoscopic cardiomyotomy was feasible without any particular problem and the postoperative course of all six patients was uneventful. The operation time was 236 (220–316) minutes, plus 38 (25–47) minutes for setup-time of the robot. At follow-up six months postoperatively, five of the six patients were free of significant dysphagia and all were free of reflux symptoms. DISCUSSION: There are several published reports, series and trials on robot-assisted laparoscopic cardiomyotomy. The general conclusion is that in experienced hands this operation is easy to perform, with a significantly lower rate of mucosal perforations, but that overall costs are higher, including a longer operation time during the learning curve. The avoidance of mucosal lacerations and their possible consequences has to be weighed against higher overall costs. CONCLUSION: Laparoscopic cardiomyotomy is the first standard laparoscopic operation where a clear advantage for use of an operation robot has been proven. Thus, wherever an operation robot is available it should be used for this procedure.

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Authors and Affiliations

  1. Department Operative Medizin, Univ.-Klinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck Medical University, Austria

    Heinz F. Wykypiel, Johannes Bodner, Florian Augustin, Oliver Renz, Elisabeth Hoeller & Thomas Schmid

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  1. Heinz F. Wykypiel
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  2. Johannes Bodner
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  3. Florian Augustin
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  4. Oliver Renz
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  5. Elisabeth Hoeller
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  6. Thomas Schmid
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Correspondence to Heinz F. Wykypiel.

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Wykypiel, H., Bodner, J., Augustin, F. et al. Robot-assisted laparoscopic cardiomyotomy. Wien Klin Wochenschr 121, 707–714 (2009). https://doi.org/10.1007/s00508-009-1270-z

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  • DOI: https://doi.org/10.1007/s00508-009-1270-z

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