Neue Technologien in der Mikrochirurgie: Potential, Indikationen und ökonomische Aspekte – Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM)

Zusammenfassung

Kürzlich haben mehrere neue Technologien zur Unterstützung von Mikrochirurg:innen eine europäische Marktzulassung erhalten. Der vorliegende Artikel fasst die Eindrücke eines Expertenpanels zur Einordnung des Potentials neuer Technologien im Hinblick auf Nutzen für den Operateur, spezifische Indikationen und ökonomische Aspekte während der 42. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) in Graz, Österreich zusammen und diskutiert diese. Das Expertengremium befasste sich im Allgemeinen mit den Grundsätzen und Voraussetzung der erfolgreichen Etablierung neuer Technologien und im Speziellen mit neuartigen optischen und robotischen Systemen. Dazu wurde die aktuelle wissenschaftliche Literatur aufgearbeitet sowie anfängliche klinische Erfahrungswerte im Rahmen von Fallserien und retrospektiven Studien durch die Mitglieder des Expertenpaneels präsentiert. In der sich anschließenden Diskussion wurde herausgearbeitet, dass zunächst eine Identifizierung von Patienten-Untergruppen notwendig sein wird, bei denen mit dem Einsatz der neuen Technologien am ehesten ein klinischer Nutzen zu erzielen sei. Da bereits eine klinische Zulassung einiger Systeme gegeben ist, kann bei der unmittelbaren klinischen Anwendung eine Vorgehensweise von möglichst einfachem Einsatz hin zu immer feineren Anwendungen, also von der Mikro- bis hin zur Supermikrochirurgie, hin entwickelt werden. Eine Finanzierung kostenintensiver Systeme sei zunächst vermutlich nicht über den Erlös aus der Regelversorgung, sondern nur durch Fördergelder oder subventionierte klinische Studien möglich. In einer abschließenden Befragung sieht die Mehrheit der Sitzungsteilnehmenden die Notwendigkeit einer Preisreduktion sowohl der Technologien zur Visualisierung als auch der Operationsrobotik, um eine flächendeckende klinische Etablierung zu ermöglichen. Ebenfalls eine Mehrheit der Teilnehmenden würde bei klinischem Einsatz eine Kombination aus Exoskop bzw. robotischem Mikroskop und einem Operationsroboter bevorzugen. Die vorliegende Konsensusarbeit adressiert die Entwicklung einer Strategie zur effektiven Etablierung neuer Technologien, die die operative Qualität ausgewählter Eingriffe weiter erhöhen soll.

Abstract

Recently, several new technologies to support microsurgeons have received European market approval. This article summarizes and discusses the impressions of an expert panel to classify the potential of new technologies in terms of benefits for the surgeon, specific indications and economic aspects during the 42nd Annual Meeting of the German-speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) in Graz, Austria. In general, the expert panel addressed the principles and prerequisite for the successful establishment of new technologies and, in particular, novel optical and robotic systems. For this purpose, the current scientific literature was reviewed and initial clinical experience in the context of case series and retrospective studies was presented by the members of the expert panel. In the ensuing discussion, it was pointed out that it will first be necessary to identify patient subgroups in which the use of the new technologies is most likely to achieve a clinical benefit. Since clinical approval has already been granted for some systems, an approach can be developed for immediate clinical application from the simplest possible use to ever finer applications, i. e. from microsurgery to supermicrosurgery. Initially, funding for cost-intensive systems would presumably not be possible through revenue from standard care, but only through grants or subsidized clinical trials. In a final survey, the majority of meeting participants see the need for a price reduction of both visualization and surgical robotics technologies to enable widespread clinical establishment. Likewise, a majority of participants would prefer a combination of an exoscope or robotic microscope and a surgical robot for clinical use. The present consensus work addresses the development of a strategy for the effective establishment of new technologies, which should further increase the surgical quality of selected interventions.

Schlüsselwörter

Supermikrochirurgie - Roboter-assistierte Chirurgie - Robotik - freie Lappenplastiken - Mikorchirurgie der Lymphgefäße

Key words

supermicrosurgery - robotic-assisted surgery - robotics - free flaps - lymphatic surgery

Publication History

Received: 10 April 2022

Accepted: 25 August 2022

Article published online:
25 October 2022

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