Robotik in der Leberchirurgie – Tipps und Tricks

Zusammenfassung

Die minimalinvasive Leberchirurgie hat nachgewiesene Vorteile gegenüber dem offenen Vorgehen. Insofern sollte die minimalinvasive Leberchirurgie auch in Deutschland breitere Anwendung finden. Die minimalinvasive Leberchirurgie hat in den vergangenen Jahren eine signifikante Entwicklung durchlaufen, in deren Rahmen sich auch die robotische Technik zunehmend etabliert. Aktuelle Analysen suggerieren geringere Blutverluste, Komplikationsraten und Krankenhausverweildauern im Vergleich zu offener und laparoskopischer Leberchirurgie. Im Gegensatz zur laparoskopischen ist das Setting bei der robotischen Technik weitgehend unabhängig von der Art der Resektion. Trotz einiger theoretischer Vorteile sollten die robotische und laparoskopische Leberchirurgie aktuell als gleichwertig erachtet werden. Allerdings deuten aktuelle Arbeiten auf Verbesserungen durch den Einsatz der Robotik hin, und das Entwicklungspotenzial der robotischen Chirurgie mithilfe von Artificial Intelligence und Machine Learning erscheint deutlich größer. Die einzelnen Operationsschritte können weitgehend aus der offenen und laparoskopischen Chirurgie übernommen werden. Für die Parenchymdissektion fehlt jedoch noch ein CUSA-System, sodass unterschiedliche Techniken und Hilfsmittel zum Einsatz kommen. Aufgrund der technischen Unterschiede zur laparoskopischen Technik sollten vor der Etablierung eines robotischen Programms intensive Übungsphasen des gesamten Teams genutzt werden.

Abstract

Since minimally invasive liver surgery has proven benefits over open surgery, this technique should also be implemented more broadly in Germany. With the dramatic development in minimally invasive and robotic liver surgery, this approach has been established in recent years. Most recent analyses suggest lower complication rates, blood loss and hospital stay compared to open and laparoscopic liver surgery. In contrast to laparoscopic surgery, the technical setting of robotic liver surgery is widely independent of the type of resection. The laparoscopic and robotic technologies should be considered to be equal at the moment, although most recent analyses even suggest additional advantages of robotic over laparoscopic liver surgery. Moreover, robotics has a greater potential for technical refinements, including the inclusion of artificial intelligence and machine learning. Most steps can be transferred from open and laparoscopic liver surgery, but a dissection device such as the CUSA has not yet been developed. Consequently, different techniques have been reported for parenchymal transsection. Due to the special technical features of robotic surgery, intensive training programs should be used prior to the establishment of a robotic liver surgery program.

Schlüsselwörter

robotische Chirurgie - Leberchirurgie - minimal-invasive Chirurgie

Keywords

robotic surgery - Liver surgery - minimal-invasive surgery

Publication History

Received: 23 May 2022

Accepted after revision: 21 March 2023

Article published online:
02 May 2023

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