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Robotergestützte Chirurgie im Kopf-Hals-Bereich

Robot-assisted surgery in the head and neck region

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Zusammenfassung

Der roboterassistierten Chirurgie (RAC) wird im Kopf-Hals-Bereich ein großes Potenzial zugeschrieben, wobei sich bereits einige zugelassene Assistenzsysteme (i. d. R. im „Master-Slave-Prinzip“) vor allem in der operativen Onkologie in der klinischen Anwendung befinden. Auch wenn prinzipiell bestimmte Patientengruppen von der Anwendung der RAC profitieren könnten, sind systematische klinische und insbesondere randomisierte Studien mit Vergleich zu den bisherigen Standardverfahren weitestgehend ausgeblieben. Daher kann ein möglicher Vorteil der RAC bislang nicht adäquat nachgewiesen werden. Auf der anderen Seite zeigt sich eine stetige Entwicklung der RAC in der Kopf-Hals-Chirurgie. Herausforderungen bestehen sowohl in technischen Limitationen, z. B. einer weiteren Miniaturisierung und der fehlenden Haptik, als auch in den hohen Anschaffungs- und Unterhaltskosten bei fehlender Gegenfinanzierung. Die aktuelle Generation von Kopf-Hals-Chirurgen wird sich jedoch sowohl technisch, wissenschaftlich als auch ethisch in einem zunehmenden Maße mit der Thematik beschäftigen dürfen oder müssen.

Abstract

Robot-assisted surgery (RAS) in the head and neck region is believed to have a large potential for the improvement of patient care. Several systems with a master-slave setup are already in routine clinical use, particularly for oncologic surgery. Although specific patient groups may benefit from RAS, there is a lack of randomized clinical studies validating the advantages of these new technological systems in comparison to the existing standard procedures. On the other hand, RAS in the head and neck region is being constantly developed. Currently, the main limitations are the technical miniaturization of the tools and the loss of haptic feedback, as well as the high costs for acquisition and maintenance without financial reimbursement. In any case, the current generation of head and neck surgeons will face the technical, scientific, and ethical challenges of RAS.

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  1. Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland

    T. K. Hoffmann, D. T. Friedrich &  P. J. Schuler

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  1. T. K. Hoffmann
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Correspondence to P. J. Schuler.

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T.K. Hoffmann, D.T. Friedrich und P.J. Schuler haben keine finanzielle Unterstützung für die Autorenschaft oder Publikation dieses Artikels erhalten. Die Autoren haben Kadaverstudien in den Räumlichkeiten der Fa. Medrobotics (USA) durchgeführt, für welche die Reisekosten übernommen worden sind. Die Autoren haben außerdem an der klinischen Studie der Fa. Medrobotics (NCT02262247) teilgenommen. Während der Studie wurde ein Unkostenbeitrag pro Fall an die Firma bezahlt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hoffmann, T.K., Friedrich, D.T. & Schuler, P.J. Robotergestützte Chirurgie im Kopf-Hals-Bereich. HNO 64, 658–666 (2016). https://doi.org/10.1007/s00106-016-0219-6

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