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Z Gastroenterol 2021; 59(01): 56-62
DOI: 10.1055/a-1329-3067
Übersicht

Robotic Liver Surgery – Current Standards and Future Perspectives

Robotische Leberchirurgie – Aktuelle Standards und Perspektiven
Felix Becker
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Haluk Morgül
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Shadi Katou
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Mazen Juratli
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Jens Peter Hölzen
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Andreas Pascher
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
,
Benjamin Struecker
  Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
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Abstract

Background Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis.

Material and methods An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery.

Results Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes.

Conclusion In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.

Zusammenfassung

Hintergrund Die robotische Leberchirurgie entwickelt sich zur Zukunft der minimalinvasiven Chirurgie. Das robotische Operationssystem bietet eine stabile Kameraplattform, Elimination des physiologischen Tremors, verbesserte chirurgische Geschicklichkeit sowie eine entspannte Ergonomie durch sitzende Position. Aufgrund theoretischer Vorteile des robotergestützten Systems erscheint die Leberchirurgie ein besonders geeignetes Feld für den Einsatz des OP Roboters zu sein, da es hohe technische Anforderung (delikate vaskuläre und parenchymatöse Präparation, intrakoroprale Anastomosen, Blutstillung) an den Chirurgen stellt.

Material und Methoden Durch die Auswertung bestehender englisch- und deutschsprachigen Literatur zur offenen, laparoskopischen sowie robotischen Leberchirurgie bietet diese Übersichtsarbeit einen Überblick über aktuelle Literatur sowie Standards und zielt darauf ab, zukünftige Entwicklungen der robotischen Leberchirurgie aufzuzeigen.

Ergebnisse Die robotische Leberchirurgie ist ein sicheres und technisch durchführbares Operationsverfahren. Im Vergleich zu offener und laparoskopischer Chirurgie zeigen sich verbesserte intra- und postoperative Outcome Daten, bei gleichwertigen onkologischen Ergebnissen.

Diskussion In komplexen Fällen, einschließlich größerer Hepatektomien, erweiterter Gallenrekonstruktionen und Segmentektomien der hinteren Segmente, stellt sich robotische Chirurgie mehr als Alternative zur offenen als zur laparoskopischen Chirurgie auf. Damit erweitert sich das Spektrum minimalinvasiver Leberchirurgie.

Key words

liver - hepatic resection - robotic surgery - minimal invasive surgery - laparoscopy

Schlüsselwörter

Leber - Leberresektion - robotische Chirurgie - Minimal invasive Chirurgie


Publication History

Received: 31 October 2020

Accepted: 03 December 2020

Article published online:
11 January 2021

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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