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Robotik im Operationssaal

Aus der Nische in die breite Anwendung

Robotics in the operating room

Out of the niche into widespread application

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Zusammenfassung

Der Operationsroboter hat sich in den letzten Jahren in der Viszeralchirurgie aus der Nische auf den Weg in eine breite Anwendung gemacht. Der Nachweis der Überlegenheit der robotischen Operationsmethoden gegenüber der Laparoskopie steht in den meisten Gebieten der Viszeralchirurgie bei weitestgehend fehlenden randomisierten Studien mit ausreichenden Fallzahlen aus. Experten sehen für komplexe Operationen, die eine aufwendige Rekonstruktionsphase benötigen, wie Pankreaskopfresektion oder auch Gastrektomie und Ösophagusresektion, das Potenzial für einen dauerhaft berechtigten Einsatz des Operationsroboters. Auch bei Operationen, bei denen eine subtile Nervenschonung bei gleichzeitiger radikaler chirurgischer Resektion notwendig ist (z. B. Rektumresektion), kann der Operationsroboter Vorteile bieten. Langfristig bietet die Roboterchirurgie durch die Integration zusätzlicher Innovationen, wie beispielsweise die Navigation oder andere Bildgebungsverfahren, Potenziale, die derzeit nur teilweise abgeschätzt werden können. Rational ist, vor einer verfrühten Euphorie zu warnen. Jedoch besteht aufgrund des vermuteten großen Potenzials die dringende Notwendigkeit, randomisierte Studien über mögliche Vorteile des Operationsroboters durchzuführen, um Evidenz zum Wohle der Patienten zu generieren.

Abstract

In the last few years robotic surgery has progressed from being confined to a small niche to a widespread application in routine visceral surgery; however, evidence for superiority of robotic surgery compared to laparoscopy from randomized studies with a sufficient number of patients is still lacking in most fields of visceral surgery. For complex operations that necessitate an extensive reconstruction phase, such as pancreatectomy, gastrectomy and esophagectomy, there is a potential benefit for the permanent and justified use of robotic surgery. Even in operations where delicate nerve preparation and radical surgical resection are simultaneously necessary, such as rectal resection, robotic surgery may provide certain benefits. In the long term there is a great potential for the integration of innovative techniques, such as navigation or other medical imaging procedures into robotic surgery, which can currently only partially be estimated. Care must be taken to avoid premature euphoria; however, due to the assumed great potential there is an urgent need for randomized studies to evaluate the possible benefits of robotic surgical techniques in visceral surgery in order to generate evidence for the welfare of patients.

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    J. Kirchberg, T. Mees & J. Weitz

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J. Kirchberg, T. Mees und J. Weitz geben an, dass kein Interessenkonflikt besteht.

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Kirchberg, J., Mees, T. & Weitz, J. Robotik im Operationssaal. Chirurg 87, 1025–1032 (2016). https://doi.org/10.1007/s00104-016-0313-z

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