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Erschienen in: Wiener klinisches Magazin 3/2021

30.04.2021 | Roboterchirurgie

Minimal-invasive und roboterassistierte Chirurgie bei chronisch entzündlicher Darmerkrankung

Aktueller Stand und Evidenzlage

verfasst von: Univ.-Prof. Dr. Peter Kienle, PD Dr. Richard Magdeburg

Erschienen in: Wiener klinisches Magazin | Ausgabe 3/2021

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Zusammenfassung

Eine Großzahl der chirurgischen Eingriffe bei chronisch entzündlicher Darmkrankheit (CED) ist minimal-invasiv durchführbar. Die Vorteile des laparoskopischen Standardvorgehens gegenüber dem offenen Vorgehen sind hinsichtlich früher und später Outcomeparameter für die Ileozökalresektion beim Morbus Crohn mit Level-I-Evidenz adäquat belegt. Für viele andere Indikationen liegen zumindest größere Register- oder Fall-Kontroll-Studien vor, die Vorteile für die Laparoskopie zeigen. Für die roboterassistierte Chirurgie ist die prinzipielle Machbarkeit gezeigt worden, wobei die limitierte Datenlage zumindest bei Colitis ulcerosa eine Vergleichbarkeit der Ergebnisse zum laparoskopischen Standardvorgehen suggeriert. Single-Port-Ansätze haben bisher keine relevanten Vorteile in der CED-Chirurgie zeigen können. Die transanale minimal-invasive Chirurgie zur Durchführung der restaurativen Proktokolektomie hat in zwei größeren Fall-Kontroll-Studien keine eindeutigen Vorteile zeigen können, hat sich aber zumindest als gleichwertige Alternative erwiesen. Insgesamt erscheint es unwahrscheinlich, dass es durch die neuen beschriebenen laparoskopischen Techniken wesentliche messbare Vorteile für den Patienten im Vergleich zum laparoskopischen Standardvorgehen geben wird, da das Zugangstrauma nicht relevant verändert wird. Generell müssen bei der Indikationsstellung zum minimal-invasiven Vorgehen immer die Grundprinzipien der CED-Chirurgie und auch die Kontraindikation im Einzelfall berücksichtigt werden, denn im Langzeitverlauf relativieren sich die Vorteile des laparoskopischen Vorgehens.
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Metadaten
Titel
Minimal-invasive und roboterassistierte Chirurgie bei chronisch entzündlicher Darmerkrankung
Aktueller Stand und Evidenzlage
verfasst von
Univ.-Prof. Dr. Peter Kienle
PD Dr. Richard Magdeburg
Publikationsdatum
30.04.2021
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 3/2021
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-021-00397-x