Kirchberg J, Weitz J
Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
Chirurg. 2019 May;90(5):379-386. doi: 10.1007/s00104-019-0812-9.
The superiority of minimally invasive operative methods compared to open surgery with respect to various parameters of short-term outcome with adequate oncological long-term results has already been confirmed for many tumor entities in high-quality studies. The continuously expanding robotic surgery offers certain additional benefits in minimally invasive oncological visceral surgery, such as a high-resolution stable 3‑dimensional view, optimal freedom of movement in situ, elimination of natural tremor and better ergonomics. This article evaluates whether these postulated advantages are reflected in an improvement of the short-term perioperative and long-term oncological results compared to conventional minimally invasive surgery in oncological visceral surgery (rectum, colon, stomach, esophagus, pancreas, liver) according to the criteria of evidence-based medicine. With the exception of colorectal surgery, there are currently no randomized controlled studies comparing robotic to laparoscopic surgery in oncological visceral surgery. There is still a clear imbalance between the exponentially expanding application of robotic surgery and the existing lack of high-quality evidence. Further randomized controlled clinical trials urgently need to be performed especially considering the great technological development potential of robotic surgery.
在高质量研究中，对于许多肿瘤实体而言，与开放手术相比，微创操作方法在短期结局的各种参数方面具有优势，且长期肿瘤学结果良好。不断发展的机器人手术在微创肿瘤内脏手术中提供了某些额外的益处，例如高分辨率稳定的三维视野、原位最佳活动自由度、消除自然震颤以及更好的人体工程学设计。本文根据循证医学标准，评估与传统微创肿瘤内脏手术（直肠、结肠、胃、食管、胰腺、肝脏）相比，这些假定的优势是否体现在短期围手术期和长期肿瘤学结果的改善上。除结直肠手术外，目前尚无关于机器人手术与腹腔镜手术在肿瘤内脏手术中比较的随机对照研究。机器人手术的应用呈指数级增长，而现有的高质量证据却不足，两者之间仍存在明显失衡。尤其考虑到机器人手术巨大的技术发展潜力，迫切需要进一步开展随机对照临床试验。
