Roboterassistierte Thoraxchirurgie bei Mediastinaltumoren

Zusammenfassung

Die roboterassistierte Thoraxchirurgie gewinnt in den letzten Jahren auch in Europa zunehmend an Bedeutung. Aufgrund des begrenzten Raumes und der engen Lagebeziehung wichtiger anatomischer Strukturen stellt die minimalinvasive Mediastinalchirurgie eine besondere Herausforderung an den Operateur dar. Aufgrund der hochauflösenden 3-D-Bildgebung, präzisen Instrumentenführung mit hoher Beweglichkeit auf kleinstem Raum eröffnet die robotisch assistierte Thoraxchirurgie im Mediastinum neue minimalinvasive Möglichkeiten und kann die Sicherheit und Radikalität bei der onkologischen Resektion von Mediastinaltumoren verbessern. Dieser Artikel gibt einen Überblick über den aktuellen Stand der roboterassistierten Mediastinalchirurgie und fasst zentrale Aspekte der Indikationsstellung, Operationsplanung und Durchführung der roboterassistierten Mediastinaltumorresektion zusammen.

Abstract

In recent years, robot-assisted thoracic surgery is gaining more and widespread interest in Europe. Due to the narrow space and the complexity of anatomical structures, conventional minimally invasive mediastinal surgery may be challenging for the thoracic surgeon. Robot-assisted mediastinal surgery opens up new possibilities for minimally invasive surgery, as it permits greater dexterity, a three-dimensional view, and tremor adjustment, which allows the surgeon to perform complex procedures in small thoracic spaces. As robotic platforms continue to evolve, more complex mediastinal thoracic surgical interventions will be facilitated, translating to improved outcomes for patients. This article provides an overview of the current status of robot-assisted mediastinal surgery and summarises general aspects of the indication, set-up and steps of robot-assisted thoracoscopic surgery in mediastinal mass resections.

Schlüsselwörter

roboterassistierte Thoraxchirurgie - RATS - Robotik - Mediastinaltumor - Thymektomie

Key words

robot-assisted surgery - RATS - mediastinal mass - thymectomy - thymoma

• Literatur

• 1 OʼSullivan KE, Kreaden US, Hebert AE. et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 2019; 8: 174-193
• 2 Zirafa CC, Romano G, Key TH. et al. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg 2019; 8: 210-217
• 3 Moller T, Egberts JH, Eichhorn M. et al. Current status and evolution of robotic-assisted thoracic surgery in Germany-results from a nationwide survey. J Thorac Dis 2019; 11: 4807-4815
• 4 Yoshino I, Hashizume M, Shimada M. et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg 2001; 122: 783-785
• 5 Rueckert J, Swierzy M, Badakhshi H. et al. Robotic-assisted thymectomy: surgical procedure and results. Thorac Cardiovasc Surg 2015; 63: 194-200
• 6 Ruckert JC, Ismail M, Swierzy M. et al. Thoracoscopic thymectomy with the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci 2008; 1132: 329-335
• 7 Ruckert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 2011; 141: 673-677
• 8 Cerfolio RJ, Bryant AS, Minnich DJ. Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg 2012; 143: 1138-1143
• 9 Marulli G, Maessen J, Melfi F. et al. Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg 2016; 5: 18-25
• 10 Amore D, Cicalese M, Scaramuzzi R. et al. Hybrid robotic thoracic surgery for excision of large mediastinal masses. J Vis Surg 2018; 4: 105
• 11 Cerfolio R, Louie BE, Farivar AS. et al. Consensus statement on definitions and nomenclature for robotic thoracic surgery. J Thorac Cardiovasc Surg 2017; 154: 1065-1069
• 12 Gonzalez-Rivas D, Ismail M. Subxiphoid or subcostal uniportal robotic-assisted surgery: early experimental experience. J Thorac Dis 2019; 11: 231-239
• 13 Pauli H, Eladawy M, Park J. Anesthesia for robotic thoracic surgery. Ann Cardiothorac Surg 2019; 8: 263-268
• 14 Chen K, Zhang X, Jin R. et al. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis 2020; 12: 105-113
• 15 Li H, Li J, Huang J. et al. Robotic-assisted mediastinal surgery: the first Chinese series of 167 consecutive cases. J Thorac Dis 2018; 10: 2876-2880
• 16 Kamel MK, Villena-Vargas J, Rahouma M. et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: a propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg 2019; 56: 762-769