De stand van zaken van robotica in abdominale chirurgie

Bert Dhondt
Persbericht

De stand van zaken van robotica in abdominale chirurgie

Robots in de operatiekamer: medische revolutie of overbodige kost?

Chirurgische robots vinden steeds meer hun ingang in het operatiekwartier. Deze innovatieve technologie stelt chirurgen in staat om heelkundige ingrepen met grote precisie uit te voeren. Ondanks de stijgende populariteit van dergelijke robots, zowel bij artsen als bij patiënten, rijst de vraag of het hoge kostenplaatje van deze systemen in evenwicht kan gebracht worden met duidelijke gezondheidsvoordelen voor de patiënt.

Hoe noemt men een chirurg die niet onder een grote, krachtige lamp, voorovergebogen over zijn patiënt aan de operatietafel staat, en gebruik makend van diverse instrumenten een heelkundige ingreep uitvoert? Een betere dokter, volgens de fabrikant van het da Vinci Surgical System en een groeiend aantal chirurgen die ervoor kiezen om een deel van hun operaties uit te voeren met behulp van een medische robot. Die robot besturen ze van op afstand vanachter een computerconsole.

De technologie gaat immers nog een stapje verder dan laparoscopiche chirurgische ingrepen, beter gekend als kijkoperaties. Daarbij gaan artsen, met behulp van smalle instrumenten en een camera, patiënten doorheen kleine incisies opereren. Dat betekende reeds een grote vooruitgang in de medische wereld, want in vergelijking met klassieke open ingrepen zijn er minder postoperatieve complicaties, sneller herstel van de patiënt en kleinere littekens. Chirurgische robots stellen chirurgen in staat om kijkoperaties met zeer natuurlijke, precieze en tremorvrije bewegingen uit te voeren, wat zelfs nog betere resultaten zou opleveren voor patiënten die een operatie ondergaan. 

Overbodige kost?

Zoals zo vaak geldt voor een nieuwe technologie, is aan de zogenaamde da Vinci robot ook een hoog prijskaartje verbonden. Voor het systeem zelf dient het ziekenhuis al om en bij de anderhalf miljoen euro op te hoesten. Het jaarlijkse onderhoud en de nood aan divers instrumentarium, waarmee de robotarmen hun taak uitvoeren, komt daar nog eens bij. Daardoor is de kostprijs van een robotgeassisteerde ingreep veel hoger dan die van kijkoperaties en klassieke operaties.

Als we dat toepassen op de principes van de gezondheidseconomie, zouden deze systemen dus enkel rendabel zijn indien ze gepaard gaan met een duidelijke gezondheidswinst ten opzichte van de huidige behandelingsopties. Dat wil zeggen: minder bijwerkingen, langere overleving en vooral betere levenskwaliteit.

Wat zegt de wetenschap?

Bij een recente studie van het UZ Gent werd  het gros van de wetenschappelijke literatuur rond de effectiviteit van robotgeassisteerde chirurgie onder de loep genomen. Men kwam tot de conclusie dat de snelle en brede invoering van robotchirurgie - zo beschikt België na de VS over het grootste aantal robotsystemen per inwoner - niet ondersteund wordt door wetenschappelijke studies van voldoende hoge kwaliteit om een significant voordeel aan te tonen ten opzichte van de huidige "gouden standaard" behandelingen.

Meer onderzoek door middel van goed uitgebouwde studies is dus nodig om na te gaan voor welke ingrepen het gebruik van een robot een meerwaarde biedt. Vooralsnog lijken dat ingrepen te zijn die moeilijk uit te voeren zijn door middel van een kijkoperatie, en dus nog steeds via de klassieke, open, manier worden aangepakt. Zo zouden ook patiënten die dergelijke moeilijke ingrepen ondergaan, kunnen genieten van de voordelen van een kijkoperatie.

Nieuw is altijd beter?

Het grote aantal da Vinci toestellen in België doet vermoeden dat medische professionals en beleidsmakers snel overtuigd waren van de voordelen van robotchirurgie. Kritische beoordeling van de wetenschappelijk literatuur hieromtrent, dient echter aan te sporen tot nuance. Zoals reeds eerder in dit artikel vermeld, doet “nieuw” er enkel toe wanneer dit duidelijke gezondheidsvoordelen biedt voor de patiënt, of dezelfde gezondheidsstandaarden behoudt aan een lagere kost.

Het is dus de vraag of grote investeringen in deze robotsystemen wel verantwoord zijn in tijden van economische onzekerheid. Er rust bijgevolg een grote verantwoordelijkheid op de schouders van medici en wetenschappers om de technologie verder te evalueren en te ontwikkelen tot een waardevolle partner in een betere zorg voor de patiënt. 

Bibliografie

 

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EXTRA REFENTIE JOURNALISTIEK ARTIKEL:

1. Vaessen C. Location of robotic surgical systems worldwide and in France. Journal of Visceral Surgery. 2011;148(5):e9-e11

Universiteit of Hogeschool
Geneeskunde
Publicatiejaar
2013
Promotor(en)
Prof. Dr. Roberto TROISI, Prof. Dr. Yves VAN NIEUWENHOVE
Kernwoorden
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