Roboterchirurgie des Pankreas

 

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Zusammenfassung

Die Pankreaschirurgie gehört zu den anspruchsvollsten Feldern der Viszeralchirurgie. Die laparoskopische Pankreaschirurgie hat sich aufgrund der hohen Komplexität insbesondere der Rekonstruktionsphase bei der Pankreatikoduodenektomie bisher jedoch nicht flächendeckend durchgesetzt. Eine Weiterentwicklung der Laparoskopie stellt die roboterassistierte Chirurgie dar. Die Vorteile sind vor allem die 3-dimensionale Sicht, die größeren Freiheitsgrade, die denen der menschlichen Hand entsprechen, und die Elimination des natürlichen Tremors. All diese Faktoren vereinfachen insbesondere das intrakorporale Nähen und Knoten immens, was insbesondere beim Anlegen der Pankreatikojejunostomie einen technischen Vorteil gegenüber der laparoskopischen Resektion darstellt. Das Verfahren wird jedoch derzeit nur in wenigen Zentren bei Pankreasresektionen angeboten. Die zumeist retrospektiven Analysen der roboterassistierten Pankreasresektionen zeigen, dass diese in geübter Hand sicher und auch onkologisch adäquat durchführbar sind. Prospektive, randomisierte Studien zum Vergleich laparoskopischer gegenüber robotischen Resektionstechniken beim Pankreas liegen aktuell nicht vor.

Abstract

Pancreatic surgery is one of the most challenging fields in visceral surgery. However, laparoscopic pancreatic surgery has not become the standard of care as yet, especially because of the very demanding reconstruction of anastomoses in pancreaticoduodenectomy. Robotic surgery has been a recent advance in laparoscopy. Its benefits are a better 3D view, a greater degree of freedom corresponding to that of the human hand, and tremor elimination. These factors greatly facilitate the intracorporeal suturing and knot-tying, which offers a technical advantage in performing pancreaticojejunostomy as compared with laparoscopic resections. However, only a few centres are offering this procedure for pancreatic resections. Retrospective analyses show that robotic pancreatic resections are safe und oncologically adequate if performed by experienced surgeons. Prospective, randomised trials comparing laparoscopic and robotic pancreatic resection techniques are not available to date.

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