Grenzen der minimalinvasiven Chirurgie

Die Penetranz minimalinvasiver Interventionen (MIC) ist auch Jahrzehnte nach ihrer Einführung bei weitem nicht zufriedenstellend. Nach unserer Einschätzung liegt dies an methodischen Einschränkungen, die eine umfassende Anwendung der MIC verhindern und die primär technisch-instrumenteller Natur sind. Konkret umfassen diese die Gewebedifferenzierung, die Kontrolle akuter Situationen, die Exposition relevanter Strukturen, die sogenannte Viszerosynthese und zudem die Präparatebergung. Die Bearbeitung dieser aufgezeigten Bereiche besitzt ein großes Potenzial für die Entwicklung minimalinvasiver Methoden, und wesentliche Verbesserungen lassen sich bereits mit vertretbarem Aufwand erreichen. In diesem Artikel werden die bestehenden Limitationen der Laparoskopie umfassend diskutiert und konkrete Lösungsansätze formuliert.

The clinical application of minimally-invasive surgery still is beyond the estimation of experts made in the past, although there is evidence of superiority in terms of postoperative recovery and pain. The unsatisfying low penetration is mainly due to methodically restriction or technical shortcomings, respectively. Clearly spoken, laparoscopic surgery is limited in terms of intraoperative tissue differentiation, in the control of acute risky situations and the exposure of relevant structures, in the reconnection of the viscerum (e.g. anastomosis) and at least in suitable methods for specimen extraction. If these limitations could be overcome laparoscopic surgery would have the potential for a much broader application. In this article we discuss current limitation of minimally invasive surgery and how they could be resolved.

Key words

Laparoscopy - robotics - intraoperative imaging - innovation - future

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