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Klinischer Stellenwert alternativer Technologien zur standardmäßigen laparoskopischen Cholezystektomie – Single-Port, Reduced-Port, Roboter, NOTES

Clinical value of alternative technologies to standard laparoscopic cholecystectomy – single port, reduced port, robotics, NOTES

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Zusammenfassung

Ein chirurgischer Eingriff sollte eine bestehende Erkrankung idealerweise kurativ versorgen und dies mit geringer Komplikationsrate und minimalem Trauma erreichen. Für die Cholezystolithiasis konnte sich die laparoskopische Cholezystektomie in diesem Sinne als anerkannter Standard etablieren. Neuere Verfahren, wie etwa der Single-Port-Ansatz oder NOTES sind angetreten, das bereits geringe Trauma des Verfahrens weiter zu reduzieren und ein besseres kosmetisches Ergebnis zu bieten. Bei allen neuen Methoden steht hierbei die Reduktion der transabdominellen Zugänge im Vordergrund des Bestrebens. Der vorliegende Beitrag versucht anhand publizierter Ergebnisse und DRG(Diagnosis Related Group)-Daten zu untersuchen, ob dieser Anspruch erreicht wird, v. a. aber soll geprüft werden, ob das Ziel auch unter Berücksichtigung der Ergebnisqualität und Komplikationsraten realisiert wurde. Neben den genannten Ansätzen werden hierbei auch die robotische Cholezystektomie und das Reduced-Port-Verfahren betrachtet.

Abstract

Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.

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Correspondence to D. Wilhelm.

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M. Berlet, A. Jell, D. Bulian, H. Friess und D. Wilhelm geben an, dass kein Interessenkonflikt besteht.

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Berlet, M., Jell, A., Bulian, D. et al. Klinischer Stellenwert alternativer Technologien zur standardmäßigen laparoskopischen Cholezystektomie – Single-Port, Reduced-Port, Roboter, NOTES. Chirurgie 93, 566–576 (2022). https://doi.org/10.1007/s00104-022-01608-9

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