Roboterassistierte thorakoskopische Zwerchfellraffung

Zusammenfassung

Das Leitsymptom des erworbenen einseitigen Zwerchfellhochstands ist die Atemnot, die typischerweise im Liegen, beim Bücken und beim Schwimmen verstärkt auftritt. Die Ätiologie ist vielfältig, wobei die idiopathische Genese und die Zwerchfellparese nach Schädigung des N. phrenicus, bspw. bei (kardio-)thorakalen Eingriffen, die häufigsten Ursachen darstellen. Trotz vielfältiger Behandlungsansätze ist die operative Zwerchfellraffung die aktuell einzige effektive Therapie. Ziel der Operation ist die Wiederherstellung der Spannung des Zwerchfells, wodurch die Atemmechanik verbessert, das Ausdehnungsvolumen erhöht und eine mögliche Kompression von basal durch abdominelle Organe verringert wird. Hierfür stehen verschiedene Operationstechniken mit verschiedenen Zugangswegen zur Verfügung. Die roboterassistierte thorakoskopische Zwerchfellraffung verbindet die Vorteile eines minimalinvasiven Zugangs mit einer hervorragenden Darstellung des Situs und einem großen Handlungsspielraum für den Operateur. Diese Operationsmethode ist sehr sicher, vergleichsweise einfach zu erlernen und geht mit deutlichen funktionalen Verbesserungen einher.

Abstract

Acquired unilateral hemidiaphragm elevation is characterised by dyspnoea, which is typically aggravated when lying down, bending over or during swimming. The most common causes are idiopathic or due to injury to the phrenic nerve during cervical or cardio-thoracic surgery. To date, surgical diaphragm plication remains the only effective treatment. The aim of the procedure is to plicate the diaphragm to restore its tension and thus improve breathing mechanics, increase the available space for the lung and reduce compression from abdominal organs. In the past, various techniques using open and minimally invasive approaches have been described. Robot-assisted thoracoscopic diaphragm plication combines the advantages of a minimally invasive approach with excellent visualisation and freedom of movement. It was shown to be a safe technique which is easy to establish and can significantly improve pulmonary function.

Schlüsselwörter

Zwerchfellraffung - Zwerchfellhochstand - roboterassistierte thorakoskopische Chirurgie

Keywords

diaphragm plication - diaphragm elevation - robot-assisted thoracoscopic surgery

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