Od otevřené klasické, přes laparoskopickou, po robotem asistovanou laparoskopickou chirurgii

From Classical Open, Via Laparoscopic to a Robot-Assissted Laparoscopic Surgery

Introduction:
Current developments in contemporary surgery include robotization of laparoscopic abdominal procedures. The author aims to give a contemporary view of the process of transition, both from a point of view of surgery prospects, as well as from a patient’s benefit point of view.

Method:
Based on literature data and on the authors’ own experience with laparoscopic surgery, the author collects results from available studies, evaluating pros of the laparoscopic procedures compared to the laparotomic ones. Furthermore, he assesses a current situation with a clinical use of the da Vinci robotic system. Development of the surgery field and a therapeutic benefit for a patient are considered the main criteria.

Results and conclusion:
Laparoscopic cholecystectomy, fundoplication for a reflux disorder, bariatric procedures and resection of the intestine have become a method of choice or an option listed as a recommended surgical treatment procedure.

Laparoscopic appendectomy has restricted indications, laparoscopic reparation of a hernia is recommended for patients, for whom early physical activity is a priority. In order for other procedures to be evaluated, current or new randomized studies need to be completed.

There are no significant differences between long-term results of either laparoscopic or laparotomic procedures.

Laparoscopic procedures have increased a price of original laparotomic procedures. However, provided better results are evidenced, it is, in most cases, accepted. It is a patient, who benefits from the laparoscopic procedures the most. A surgeon’s work ergonomy during laparoscopic procedures with prolonged static body positions may often be worse than during open surgery.

Also the procedure itself is, in most cases, more time-demanding.

Robot assistence in laparoscopic surgery is a new and fast developing technology of this decade. Currently, its development is in the initial phase. Miniinvasive features are identical with conventional laparoscopic procedures.

In order to assess patient’s benefits from a robotic system application, the system must be compared with a conventional laparoscopic technique and its results, using randomized studies.

The pros of the robotic system include 3D visualization, significantly improved mobility of instruments, better surgeon’s ergonomy and elimination of hand shake transition on an instrument.

Current disadvantage of the da Vinci robotic system is a high purchase price of the device, costly use due to expensive instrumentation and, so far, not yet confirmed benefits for a patient during abdominal surgery.

Pilot projects must be completed to assess the robotic system in abdominal surgery.

Key words:

laparoscopic surgery – robotic system da Vinci – randomized studies