Stellenwert der Robotik in der Leber- und Nierenlebendspende – Überblick über die aktuelle Studienlage und Ergebnisse einer Umfrage unter den deutschen Transplantationszentren

Zusammenfassung

Hintergrund

Die Vorteile minimalinvasiver Operationstechniken sind unbestritten. Mit der Einführung robotischer Assistenzsysteme wurde die klassische Laparoskopie weiterentwickelt und wird nun auch in der bisher von offenen Operationsverfahren geprägten Transplantationschirurgie eingesetzt, insbesondere bei Lebendspende-Operationen von Leber und Niere. Um den aktuellen Stand der Implementierung von robotischen Assistenzsystemen in der Transplantationschirurgie zu untersuchen, wurden die Ergebnisse internationaler Studien auf diesem Gebiet zusammengefasst und mit einer nationalen Befragungsstudie zum Einsatz der robotischen Lebendspende korreliert.

Methoden

Es erfolgte zunächst eine narrative Zusammenfassung der MEDLINE-gelisteten Publikationen zum Thema robotische Nieren- und Leberlebendspende. Zusätzlich erfolgte eine Onlineumfrage unter den deutschen Lebendspendezentren mit 10 Fragen zum Einsatz der Robotik in der deutschen Transplantationschirurgie.

Ergebnisse

International berichten insbesondere retrospektive Kohortenstudien aus wenigen Transplantationszentren von Vorteilen durch die Robotik, z. B. hinsichtlich Blutverlust, Patientenkomfort und Dauer des Krankenhausaufenthaltes. Bereits ein Drittel der deutschen Transplantationszentren führt Nierenlebendspende-Operationen robotisch assistiert durch, ein Fünftel der Zentren benutzt diese Technik nahezu ausschließlich (> 90% der Nierenlebendspenden). Ein anderes Bild ergibt sich bei der Leberlebendspende, wo nur eines der befragten Zentren begonnen hat, die linkslaterale Donorhepatektomie robotisch assistiert durchzuführen.

Schlussfolgerung

Im Kontext der Lebendspende betonen Befürworter der Robotik technische Vorteile, höheren Patientenkomfort und eine steilere Lernkurve. Ein fortbestehender erheblicher Kritikpunkt an der robotischen Operationstechnik bleibt eine verlängerte warme Ischämiezeit, vor allem während der individuellen Lernkurve. Die hier vorgestellten Umfrageergebnisse zeigen, dass zu diesem aktuellen Thema weiterhin ein großer Diskussionsbedarf besteht, wobei randomisiert-kontrollierte Studien fehlen.

Abstract

Background

The advantages of minimally invasive surgical techniques are undisputed. With the introduction of robotic assistance systems, classic laparoscopy has been further developed and is now also being utilized in transplant surgery, which was previously mainly characterised by open surgical procedures, particularly in living donor liver and kidney donations. In order to assess the current implementation status of robotic assistance systems in transplant surgery, international studies in this field were summarized and correlated with a national survey on the use of robotic assistance systems in living donation.

Methods

First, a narrative summary of the MEDLINE-listed publications on robotic living kidney and liver donation was carried out. In addition, an online survey was conducted among German transplant centres with ten questions on the utilization of robotic techniques in Germany.

Results

Retrospective cohort studies at a small number of transplant centres worldwide report particular advantages of robotics, especially regarding blood loss, patient comfort and length of hospital stay. One-third of German transplant centres already perform living kidney donations with robotic assistance, and one-fifth of centres even use this technique in over 90% of cases. In contrast, living liver donations are only performed in one German transplant centre using robotic assistance for left lateral liver resection of the donor.

Conclusion

In the context of living donation, advocates of robotics emphasise technical advantages, greater patient comfort and a steeper learning curve. A persistent and significant point of criticism regarding robotic surgical techniques remains the prolonged warm ischemia time, especially during learning curves. The survey results presented here demonstrate that there is still a substantial need for discussion on this current topic. However, there is a lack of prospective randomised controlled studies.

Schlüsselwörter

Leberlebendspende - Nierenlebendspende - Lebertransplantation - Nierentransplantation - robotische Chirurgie - minimalinvasive Chirurgie

Keywords

living donor liver transplantation - living donor kidney transplantation - robotic surgery - minimally invasive surgery - liver transplantation - kidney transplantation

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