Reduktion des Zugangstraumas: gesicherte Vorteile

Abstract

Minimizing the trauma of surgical access is becoming an essential task in modern surgery. The treatment has to become more comfortable for the patient and financial resources have to be considered. Minimally invasive surgery is one of the attempts to achieve this goal. A comparison of surgical procedures, such as cholecystectomy, fundoplication and sigmoid resection in diverticulitis, which are already routinely performed laparoscopically, should be suitable for evaluating whether minor access surgery is really advantageous. The value of minor access may be quantified by different parameters such as influence upon the immunologic function, lung function, postoperative pain, time of hospitalization, return to work and duration of convalescence, as well as a comparison of the effects upon the quality of life index. The data concerning the effects upon immunology are not unequivocal. All in all, the degree of postoperative inflammation seems to be lower after laparoscopic surgery. There is no doubt that there is far less impairment on lung function, the results are better as far as postoperative pain is concerned, and hospitalization and duration of convalescence are shorter. It is also evident that immediately after the operation the quality of life index is superior, which, however, levels out in the course of time. The advantage of minimally invasive surgery is really apparent only after the mastering of the so-called "learning curve" and in cases of benign malignancies. The role of the minor access approach in oncological surgery is, however, not yet defined.

Recent Advances in Minimally Invasive Colorectal Cancer Surgery

“…Until now, only few prospective clinical studies were published that compare the immunological response to laparoscopic with that to conventional surgery for colorectal cancer. Nonetheless, IL-6 and C-reactive protein levels were reported to be lower after la- paroscopic rectosigmoid resections [16]. This observation was also confirmed in a recent pilot study in our institution.…”

“…Furthermore, there is no doubt that far less impairment of lung function occurs after minimal invasive surgery [16]. Moreover, less postoperative pain, shorter duration of hospitalization, and faster recovery have been observed after laparoscopic colorectal cancer surgery when compared with the conventional approach [16,35]. The observed advantages in quality of life however level out in the course of time [8].…”

“…Nonetheless, the degree of postoperative inflammation seems to be lower after laparoscopic surgery [16]. Furthermore, there is no doubt that far less impairment of lung function occurs after minimal invasive surgery [16]. Moreover, less postoperative pain, shorter duration of hospitalization, and faster recovery have been observed after laparoscopic colorectal cancer surgery when compared with the conventional approach [16,35].…”

“…Despite numerous publications addressing this interesting clinical issue, there is no scientific evidence-based answer to the question of whether or not the above-mentioned hypothesis on the advantages of minimal access surgery holds true. Nonetheless, the degree of postoperative inflammation seems to be lower after laparoscopic surgery [16]. Furthermore, there is no doubt that far less impairment of lung function occurs after minimal invasive surgery [16].…”

“…Until now, the available trials assessing the value of laparoscopy in colorectal cancer, however, lacked sufficient statistical power due to small numbers of patients or had short follow-up periods which did not allow proper evaluation of the oncological safety [1]. Thus, despite the observed clinical advances of the minor access approach, the role of minimal invasive procedures in oncological surgery is not yet defined [16]. We discuss herein the established procedures of minimally invasive surgery for colorectal disease as well as the current role of laparoscopic surgery for colorectal carcinoma with special attention to surgical safety (length of surgery, blood loss, perioperative morbidity, and mortality rates) as well as the oncological results (number of harvested lymph nodes, length of security margins, long-term survival).…”