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Minimal-invasive und robotisch assistierte Operationstechniken in der onkologischen Magen- und Ösophaguschirurgie

Minimally invasive and robotic-assisted surgical management of upper gastrointestinal cancer

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Zusammenfassung

Die total-minimal-invasiven onkologischen Magen- und Ösophagusresektionen werden derzeit überwiegend in Zentren durchgeführt. Die Vorteile dieser Operationstechniken bestehen vor allem in der Reduktion des operativen Traumas mit gleichzeitig lupenhafter Vergrößerung des Operationssitus und daraus resultierender erhöhter operativer Präzision. Die robotisch assistierte minimal-invasive Ösophagektomie (RAMIE) und laparoskopische/thorakoskopische Ösophagektomie (MIE) sind derzeit die gängigsten minimal-invasiven Operationstechniken für die onkologische Speisenröhrenresektion. Die laparoskopische Gastrektomie (MIG) bzw. robotisch assistierte minimal-invasive Gastrektomie (RAG) stellen das Pendant für die D2-Gastrekomie dar. Aufgrund zu geringer Fallzahlen kann noch keine abschließende Beurteilung zur Überlegenheit dieser Operationstechniken gegenüber Hybrid- bzw. offenen Operationstechniken vorgenommen werden. Jedoch deuten die Studien von High-volume-Zentren, in denen diese Verfahren routinemäßig zum Einsatz kommen, auf eine Überlegenheit dieser Verfahren hinsichtlich Morbidität hin. In unseren Kliniken werden alle vier beschrieben Operationstechniken standardisiert eingesetzt und wir sind von den Vorteilen dieser Techniken hinsichtlich Morbidität gegenüber offenen oder Hybridtechniken überzeugt. Die Mehrkosten minimal-invasiver und robotischer Verfahren müssen in Relation zu den Gesamtkosten und der möglichen Reduktion von Morbidität und Personalkosten sowie neuen operativen Möglichkeiten (Real-time-Fluoroskopie) gesetzt werden.

Abstract

Total minimally invasive upper gastrointestinal resections are currently mainly performed in centers. The advantages include reduction of operative trauma, magnified enlargement of the operation field and the resulting improvement in operative precision. Robotic-assisted minimally invasive esophagectomy (RAMIE) and laparoscopic/thoracoscopic minimally invasive esophagectomy (MIE) are currently the most commonly performed strategies for esophageal cancer. Laparoscopic (MIG) and robotic-assisted gastrectomy (RAG) are the equivalent procedures for gastric cancer. Due to the relatively low number of reported cases, no definitive statement regarding superiority of these procedures compared to standard open or hybrid procedures can be made; however, there is mounting evidence from high-volume centers in which these procedures are routinely performed that there might be an advantage regarding perioperative morbidity. All of the four procedures described are provided at our high-volume centers in a standardized manner and we are convinced of the benefits of these minimally invasive techniques with respect to morbidity compared to open and hybrid techniques. The additional costs of this technology have to be off-set against a possible reduction of morbidity, reduced cost for personnel and new operative options, such as real-time fluoroscopy.

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Hinweis zu den Abbildungen

Die im Beitrag vorliegenden Abbildungen wurden zur Verfügung gestellt von: Abb. 1–5 und 7–9, Copyright P. Grimminger Abb. 6 und 10, Copyright H. Fuchs.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Johannes Gutenberg Universität Mainz, Mainz, Deutschland

    P. P. Grimminger

  2. Klinik und Poliklinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universität zu Köln, Kerpener Str. 62, Köln, Deutschland

    H. F. Fuchs

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Correspondence to H. F. Fuchs.

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Interessenkonflikt

P.P. Grimminger und H.F. Fuchs geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Grimminger, P.P., Fuchs, H.F. Minimal-invasive und robotisch assistierte Operationstechniken in der onkologischen Magen- und Ösophaguschirurgie. Chirurg 88, 1017–1023 (2017). https://doi.org/10.1007/s00104-017-0522-0

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