Computer- und Roboter-assistierte Viszeralchirurgie - Status quo und Perspektive

Zusammenfassung

Die Computer- und Roboter-assistierte Chirurgie hat sich bisher besonders in der Neurochirurgie und Orthopädie etabliert. Anwendung finden Planungs- und Visualisierungstools, Orientierungshilfen durch chirurgische Navigationstechnologien, sowie Bewegungsautomaten und telechirurgische Systeme. Vorteile ergeben sich vor allem durch eine Erweiterung der visuellen Wahrnehmung, sowie durch eine bessere anatomische Orientierung. Eine Unterstützung des chirurgischen Geschicks ist möglich durch Steigerung der Präzision. Weitere Vorteile ergeben sich für die Ausbildung in der Chirurgie sowie für die Analyse und Dokumentation chirurgischer Manipulationen. In der Viszeralchirurgie hat sich vor allem die 3D-Simulation in der Leberchirurgie etabliert. Die Anwendung und Wertigkeit von Kameraführungssystemen und telechirurgischen Systemen in der Viszeralchirurgie wird anhand der aktuellen Literatur und den eigenen Erfahrungen erörtert. Vielversprechend erweist sich bisher die Computerassistenz in der Leberchirurgie, sowie telechirurgische Techniken bei komplexen laparoskopischen Eingriffen unter eingeengten Raumverhältnissen. Mit zunehmender Weiterentwicklung minimalinvasiver Verfahren werden die Perspektiven für die Computer- und Robotertechnologie in der Viszeralchirurgie steigen.

Abstract

Computer- and Robot-assistance is mainly used in neurosurgery and orthopaedics. Tools for surgical planning and visualisation, navigational systems, as well as action automatation and telesurgical systems are available. These systems support surgical skill by enhanced visual perception, improved anatomical orientation and high precision. There are also potential benefits for surgical education, as well as evaluation and documentation of surgical manipulation. In abdominal surgery 3D-simulation has proved of value in liver surgery. The practice and impact of telesurgical systems and devices for camera guidance are argued on the basis of reports from literature and own experience. Computer assistance is very helpful for major liver resections, while telesurgical techniques may allow to perform complex surgical manipulations in narrow anatomical spaces. With further development of minimally invasive procedures the impact of computer- and robot-technology will increase.

Schlüsselwörter

Abdomen - Chirurgie - Computer - Robotik - Telechirurgie

Key words

Abdominal - surgery - computer - robotic - telesurgery

Literatur

• 1 Lang H, Radtke A, Hindennach M. et al . Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection.  Arch Surg. 2005;  140 629-638
• 2 Marescaux J, Clement J M, Tassetti V. et al . Virtual reality applied to hepatic surgery simulation: the next revolution.  Ann Surg. 1998;  228 627-634
• 3 Grunert P, Darabi K, Espinosa J. et al . Computer-aided navigation in neurosurgery.  Neurosurg Rev. 2003;  26 73-99
• 4 Gebhard F, Weidner A, Liener U C. et al . Navigation at the spine.  Injury. 2004;  35 (Suppl 1) S35-S45
• 5 Siebel T, Kafer W. Modification of the posterior cruciate ligament tension following total knee arthroplasty: comparison of the Genesis CR and LCS meniscal bearing prostheses.  Knee. 2004;  11 203-208
• 6 Siebert W, Mai S, Kober R. et al . Technique and first clinical results of robot-assisted total knee replacement.  Knee. 2002;  9 173-180
• 7 Mazoochian F, Pellengahr C, Huber A. et al . Low accuracy of stem implantation in THR using the CASPAR-system: anteversion measurements in 10 hips.  Acta Orthop Scand. 2004;  75 261-264
• 8 Wu L D, Hahne H J, Hassenpflug J. The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty.  J Zhejiang Univ Sci. 2004;  5 1270-1278
• 9 Schneider J, Kalender W. Geometric accuracy in robot-assisted total hip replacement surgery.  Comput Aided Surg. 2003;  8 135-145
• 10 Omote K, Feussner H, Ungeheuer A. et al . Self-guided robotic camera control for laparoscopic surgery compared with human camera control.  Am J Surg. 1999;  177 321-324
• 11 Satava R. Robotics, telepresence and virtual reality: a critical analysis of the future of surgery.  Min Invasiv Ther. 1992;  1 11-16
• 12 Marescaux J, Leroy J, Rubino F. et al . Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.  Ann Surg. 2002;  235 487-492
• 13 Senapati S, Advincula A P. Telemedicine and robotics: Paving the way to the globalization of surgery.  Int J Gynaecol Obstet. 2005;  91 210-216
• 14 Gandsas A, McIntire K, Montgomery K. et al . The personal digital assistant (PDA) as a tool for telementoring endoscopic procedures.  Stud Health Technol Inform. 2004;  98 99-103
• 15 Jaspers J E, Breedveld P, Herder J L. et al . Camera and instrument holders and their clinical value in minimally invasive surgery.  Surg Laparosc Endosc Percutan Tech. 2004;  14 145-152
• 16 Jaspers J E, Breedveld P, Herder J L. et al . Camera and instrument holders and their clinical value in minimally invasive surgery.  Surg Laparosc Endosc Percutan Tech. 2004;  14 145-152
• 17 Moorthy K, Munz Y, Dosis A. et al . Dexterity enhancement with robotic surgery.  Surg Endosc. 2004;  18 790-795
• 18 Verner L, Oleynikov D, Holtmann S. et al . Measurements of the level of surgical expertise using flight path analysis from da Vinci robotic surgical system.  Stud Health Technol Inform. 2003;  94 373-378
• 19 Niemeyer G, Kuchenbecker K J, Bonneau R. et al . THUMP: an immersive haptic console for surgical simulation and training.  Stud Health Technol Inform. 2004;  98 272-274
• 20 Chitwood Jr  W R, Nifong L W, Chapman W H. et al . Robotic surgical training in an academic institution.  Ann Surg. 2001;  234 475-484
• 21 Marvik R, Lango T, Tangen G A. et al . Laparoscopic navigation pointer for three-dimensional image-guided surgery.  Surg Endosc. 2004;  18 1242-1248
• 22 Lang H, Radtke A, Hindennach M. et al . Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection.  Arch Surg. 2005;  140 629-638
• 23 Hildebrandt U, Plusczyk T, Kessler K. et al . Single-surgeon surgery in laparoscopic colonic resection.  Dis Colon Rectum. 2003;  46 1640-1645
• 24 Kraft B M, Jager C, Kraft K. et al . The AESOP robot system in laparoscopic surgery: increased risk or advantage for surgeon and patient?.  Surg Endosc. 2004;  18 1216-1223
• 25 Bonatti J, Schachner T, Bonaros N. et al . Ongoing procedure development in Robotically Assisted Totally Endoscopic Coronary Artery Bypass Grafting (TECAB).  Heart Surg Forum. 2005;  8 E287-E291
• 26 Jacobsen G, Elli F, Horgan S. Robotic surgery update.  Surg Endosc. 2004;  18 1186-1191
• 27 Cadiere G B, Himpens J, Vertruyen M. et al . Evaluation of telesurgical (robotic) NISSEN fundoplication.  Surg Endosc. 2001;  15 918-923
• 28 Drasin T, Dutson E, Gracia C. Use of a robotic system as surgical first assistant in advanced laparoscopic surgery.  J Am Coll Surg. 2004;  199 368-373
• 29 Costi R, Himpens J, Iusco D. et al . [Robotic fundoplication for gastro-oesophageal reflux disease].  Chir Ital. 2004;  56 321-331
• 30 Muhlmann G, Klaus A, Kirchmayr W. et al . DaVinci robotic-assisted laparoscopic bariatric surgery: is it justified in a routine setting?.  Obes Surg. 2003;  13 848-854
• 31 Moser F, Horgan S. Robotically assisted bariatric surgery.  Am J Surg. 2004;  188 38-44
• 32 Miller D W, Schlinkert R T, Schlinkert D K. Robot-assisted laparoscopic cholecystectomy: initial Mayo Clinic Scottsdale experience.  Mayo Clin Proc. 2004;  79 1132-1136
• 33 Bodner J, Hoeller E, Wykypiel H. et al . Long-term follow-up after robotic cholecystectomy.  Am Surg. 2005;  71 281-285
• 34 Roeyen G, Chapelle T, Ysebaert D. Robot-assisted choledochotomy: feasibility.  Surg Endosc. 2004;  18 165-166
• 35 Hourmont K, Chung W, Pereira S. et al . Robotic versus telerobotic laparoscopic cholecystectomy: duration of surgery and outcomes.  Surg Clin North Am. 2003;  83 1445-1462
• 36 Nio D, Bemelman W A, Busch O R. et al . Robot-assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a comparative study.  Surg Endosc. 2004;  18 379-382
• 37 Zhou H X, Guo Y H, Yu X F. et al . Zeus robot-assisted laparoscopic cholecystectomy in comparison with conventional laparoscopic cholecystectomy.  Hepatobiliary Pancreat Dis Int. 2006;  5 115-118
• 38 Horgan S, Berger R A, Elli E F. et al . Robotic-assisted minimally invasive transhiatal esophagectomy.  Am Surg. 2003;  69 624-626
• 39 Elli E, Espat N J, Berger R. et al . Robotic-assisted thoracoscopic resection of esophageal leiomyoma.  Surg Endosc. 2004;  18 713-716
• 40 Kernstine K H, DeArmond D T, Karimi M. et al . The robotic, 2-stage, 3-field esophagolymphadenectomy.  J Thorac Cardiovasc Surg. 2004;  127 1847-1849
• 41 Ruurda J P, Draaisma W A, van Hillegersberg R. et al . Robot-assisted endoscopic surgery: a four-year single-center experience.  Dig Surg. 2005;  22 313-320
• 42 Espat N J, Jacobsen G, Horgan S. et al . Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy.  Cancer J. 2005;  11 10-17
• 43 Horgan S, Galvani C, Gorodner M V. et al . Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study.  J Gastrointest Surg. 2005;  9 1020-1029
• 44 Weber P A, Merola S, Wasielewski A. et al . Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease.  Dis Colon Rectum. 2002;  45 1689-1694
• 45 Braumann C, Jacobi C A, Menenakos C. et al . Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences.  Dis Colon Rectum. 2005;  48 1820-1827
• 46 Delaney C P, Lynch A C, Senagore A J. et al . Comparison of robotically performed and traditional laparoscopic colorectal surgery.  Dis Colon Rectum. 2003;  46 1633-1639
• 47 Munz Y, Moorthy K, Kudchadkar R. et al . Robotic assisted rectopexy.  Am J Surg. 2004;  187 88-92
• 48 Anvari M, Birch D W, Bamehriz F. et al . Robotic-assisted laparoscopic colorectal surgery.  Surg Laparosc Endosc Percutan Tech. 2004;  14 311-315
• 49 Moinzadeh A, Gill I S. Robotic adrenalectomy.  Urol Clin North Am. 2004;  31 753-756
• 50 Winter J M, Talamini M A, Stanfield C L. et al . Thirty robotic adrenalectomies: a single institution's experience.  Surg Endosc. 2005;  20 119-124
• 51 Brunaud L, Bresler L, Zarnegar R. et al . Does robotic adrenalectomy improve patient quality of life when compared to laparoscopic adrenalectomy?.  World J Surg. 2004;  28 1180-1185
• 52 Morino M, Beninca G, Giraudo G. et al . Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial.  Surg Endosc. 2004;  18 1742-1746
• 53 Seelig M H, Senninger N, Kocher T. [Laparoscopic splenectomy: first experiences with a 3-trocar-technique and the ‘hanging-spleen-maneuver’].  Zentralbl Chir. 2004;  129 387-390
• 54 Bodner J, Kafka-Ritsch R, Lucciarini P. et al . A critical comparison of robotic versus conventional laparoscopic splenectomies.  World J Surg. 2005;  29 982-985
• 55 Melvin W S. Minimally invasive pancreatic surgery.  Am J Surg. 2003;  186 274-278
• 56 Kleemann M, Hildebrand P H, Mirow L. et al . Navigation in der Viszeralchirurgie.  Chir Gastroenterol. 2005;  21 (Suppl 2) 1-7
• 57 Lange T, Eulenstein S, Hunerbein M. et al . Vessel-based non-rigid registration of MR/CT and 3D ultrasound for navigation in liver surgery.  Comput Aided Surg. 2003;  8 228-240
• 58 Chitwood  Jr W R, Nifong L W, Chapman W H. et al . Robotic surgical training in an academic institution.  Ann Surg. 2001;  234 475-484
• 59 Melvin W S, Needleman B J, Krause K R. et al . Computer-enhanced vs. standard laparoscopic antireflux surgery.  J Gastrointest Surg. 2002;  6 11-15
• 60 Gutt C N, Markus B, Kim Z G. et al . Early experiences of robotic surgery in children.  Surg Endosc. 2002;  16 1083-1086
• 61 Talamini M, Campbell K, Stanfield C. Robotic gastrointestinal surgery: early experience and system description.  J Laparoendosc Adv Surg Tech A. 2002;  12 225-232
• 62 Beninca G, Garrone C, Rebecchi F. et al . [Robot-assisted laparoscopic surgery. Preliminary results at our Center].  Chir Ital. 2003;  55 321-331
• 63 Bodner J, Wykypiel H, Wetscher G. et al . First experiences with the da Vinci operating robot in thoracic surgery.  Eur J Cardiothorac Surg. 2004;  25 844-851
• 64 Knight C G, Lorincz A, Gidell K M. et al . Computer-assisted robot-enhanced laparoscopic fundoplication in children.  J Pediatr Surg. 2004;  39 864-866
• 65 Ruurda J P, Gooszen H G, Broeders I A. Early experience in robot-assisted laparoscopic Heller myotomy.  Scand J Gastroenterol. 2004;  Suppl 4-8
• 66 Mohr C J, Nadzam G S, Curet M J. Totally robotic Roux-en-Y gastric bypass.  Arch Surg. 2005;  140 779-786
• 67 Ali M R, Bhaskerrao B, Wolfe B M. Robot-assisted laparoscopic Roux-en-Y gastric bypass.  Surg Endosc. 2005;  19 468-472
• 68 Marescaux J, Smith M K, Folscher D. et al . Telerobotic laparoscopic cholecystectomy: initial clinical experience with 25 patients.  Ann Surg. 2001;  234 1-7
• 69 Ruurda J P, Broeders I A, Simmermacher R P. et al . Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies.  Surg Laparosc Endosc Percutan Tech. 2002;  12 41-45
• 70 Ruurda J P, Visser P L, Broeders I A. Analysis of procedure time in robot-assisted surgery: comparative study in laparoscopic cholecystectomy.  Comput Aided Surg. 2003;  8 24-29
• 71 Talamini M A, Chapman S, Horgan S. et al . A prospective analysis of 211 robotic-assisted surgical procedures.  Surg Endosc. 2003;  17 1521-1524
• 72 Corcione F, Esposito C, Cuccurullo D. et al . Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience.  Surg Endosc. 2005;  19 117-119
• 73 Heemskerk J, van Dam R, van Gemert W G. et al . First results after introduction of the four-armed da Vinci surgical system in fully robotic laparoscopic cholecystectomy.  Dig Surg. 2006;  22 426-431
• 74 Brunaud L, Bresler L, Ayav A. et al . [Advantages of using robotic Da Vinci system for unilateral adrenalectomy: early results].  Ann Chir. 2003;  128 530-535
• 75 Brunaud L, Bresler L, Zarnegar R. et al . Does robotic adrenalectomy improve patient quality of life when compared to laparoscopic adrenalectomy?.  World J Surg. 2004;  28 1180-1185
• 76 Winter J M, Talamini M A, Stanfield C L. et al . Thirty robotic adrenalectomies: a single institution's experience.  Surg Endosc. 2006;  20 119-124