Zusammenfassung:
Die mit dem endoskopischen Standardinstrumentarium verbundenen Einschränkungen in der Bewegungsfreiheit haben eine komplett endoskopische Herzchirurgie bisher nicht zugelassen. Besonders die Einschränkungen durch den knöchernen Thorax haben bisher entsprechende Entwicklungen verhindert. Mit Hilfe von Telemanipulator-Systemen kann erstmals eine Präzision erzielt werden, die endoskopische Eingriffe am Herzen für die Bypasschirurgie und Klappenrekonstruktionen ermöglicht. Voraussetzung hierfür sind kardiopulmonale Bypassverfahren, die einen kardioplegischen Herzstillstand bei geschlossenem Thorax erlauben sowie ein umfangreiches hämodynamisches Monitoring, das ohne direkte Sicht auf das Herz eine sichere Diagnosestellung für den Anästhesisten ermöglicht. Nach ausgiebigen experimentellen Vorarbeiten wird ein Telemanipulationssystem seit Mai 1998 im Herzzentrum Leipzig erfolgreich klinisch eingesetzt.
Robot-Assisted Surgery - Surgical and Anesthesiological Implications.
Because of the restricted freedom of movement inherent in endoscopic standard instruments wholly endoscopic heart surgery has not been possible up to now. The development of such techniques was especially hindered by the rib cage. Now the precision which is imperative for bypass surgery or valve reconstruction is made possible by telemanipulator systems. Preconditions for this method are cardiopulmonary bypass-techniques which allow a cardioplegic cardiac arrest with closed chest and extensive hemodynamic monitoring which enables the anesthesiologist to make exact diagnoses without having a direct view on the heart. After an extensive experimental phase a telemanipulation system is successfully in use since May 1998 in the Cardiac Center in Leipzig.
Schlüsselwörter:
Roboterassistierte Chirugie - Minimal invasive Chirurgie - Intraoperatives TEE
Key words:
Robotassisted surgery - Minimal invasive surgery - Intraoperative TEE
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Dr. Jörg Ender
Universität Leipzig Herzzentrum
Russenstraße 19
04289 Leipzig
Email: endj@medizin.uni-leipzig.de
