Rektumkarzinom – Robotic Setup, Port Placement, strukturierte OP-Schritte

Zusammenfassung

Die robotische tiefe anteriore Rektumresektion beim Rektumkarzinom findet zunehmend Verbreitung in Europa. Es ergeben sich sowohl onkologisch als auch funktionell potenzielle Vorteile gegenüber dem konventionellen laparoskopischen Zugang. Die neue Generation der Operationsroboter, insbesondere das Da-Vinci-Xi-System von Intuitive, erweitert die Möglichkeiten des robotischen Zuganges, insbesondere bei der Mobilisation der linken Kolonflexur. Dementsprechend kann die tiefe anteriore Resektion sicher, komplikationsarm und ohne Hybridunterstützung robotisch durchgeführt werden. In der vorliegenden Arbeit werden das Setup des Roboters, das Port Placement und die Operationsschritte bei der robotischen tiefen anterioren Resektion beschrieben. Hierbei werden sowohl die Besonderheiten des Da-Vinci-Xi- als auch des -X-Systems hervorgehoben. Potenzielle Vorteile gegenüber dem laparoskopischen Zugang durch eine bessere 3-dimensionale Visualisierung des Operationssitus durch eine Erhöhung der Bewegungsfreiheitsgrade und durch eine erhöhte Präzision der Instrumentenführung können zu verbesserten Resultaten der Rektumchirurgie führen. Bisher ist die Evidenz allerdings zu schwach, um die robotische tiefe anteriore Rektumresektion als Standardzugang beim Rektumkarzinom zu empfehlen.

Abstract

Robotic low anterior resection in rectal carcinoma is becoming increasing common in Europe. There may be oncological and functional advantages as compared to laparoscopic approaches. The new generation of surgical robots, such as the Da Vinci Xi systems from Intuitive, enlarges the range of robotic access, especially in the mobilisation of the left flexure. Thus, robotic low anterior resection can now be performed safely, with low morbidity and without hybrid support. In this paper, the setup of the robotic system, port placement and surgical steps of robotic low anterior rectal resection are explained. Special features of Da Vinci Xi- and -X-systems are emphasised. Potential advantages of the robotic access – such as 3-dimensional visualisation of the surgical field, wrist-like movements of instruments and increased precision – may provide better results in rectal surgery than with laparoscopic access. Nevertheless, the evidence is still too weak to recommend robotic low anterior resection as the standard procedure in rectal cancer.

Schlüsselwörter

robotisch assistierte Chirurgie - Portplatzierung - Rektumkarzinom - tiefe anteriore Rektumresektion

Key words

robotic-assisted surgery - low anterior rectal resection - port placement - rectal cancer

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