[Robots in visceral and thoracic surgery-Quo vadis?].

Robotic surgical systems are now an inherent part of the German hospital landscape. In recent years, there has been an enormous increase in installed systems and operations performed, especially in abdominal surgery. Even though there is a lack of studies with the highest grade of evidence, the advantages of the technique are obvious-particularly technically demanding operations can now be performed safely and less invasively for patients. Robotics are now being implemented in many non-university institutions. At the Israelite Hospital (Israelitisches Krankenhaus) Hamburg it could be demonstrated that with systematic and modular training, i.e. execution of certain surgical steps, it is possible to significantly flatten the learning curve while maintaining excellent oncological quality, postoperative morbidity and mortality. The costs to have a system up and running are the main limitations for the implementation of robotic surgery. The acquisition, material and maintenance costs are substantial so that the type of intervention and the training of prospective surgeons are limited by the costs. The robotic approach will fully unroll its disruptive character compared to laparoscopy once it is competitive not only qualitatively in the field of medical contents but also economically. In the future the ROBIN working group of the German Society for General and Visceral Surgery (DGAV) wants to create the basic prerequisites for valid studies by working with registers and could act as an independent central intermediary between hospitals and the industry to promote practical innovations and systematic training for surgeons.