Sunday, May 28, 2023

Robotic surgery: a method that increases surgical precision and is used in a hospital in Argentina

Enrique Rivero is 66 years old and has suffered from prostate cancer. In 2021, he underwent surgery in which that entire organ was removed. The main thing is that he intervenes in the operation of the robot surgeon, DaVinci XI.

“I did not feel any pain or any discomfort. It was recovered very quickly. I was in the hospital for 48 hours. The next day I was able to return to my home. I was surprised that I thought that the hospitalization would take much longer”, he describes the results in disbelief and content. The intervention is called “radical robotic prostatectomy” (full removal of the prostate) and was performed at the Otamendi Sanatorium.

Hybrid robotic surgery is a surgical technique that combines robotic technology and minimally invasive surgery to improve the precision and efficiency of operations. In health, they changed the way of diagnosing, treating and even preventing certain diseases.

Surgical robots help the surgeon, who sits at the control console, to perform a precise and complex procedure on the operating table, where a multidisciplinary team intervenes. They are already working in some clinics in Argentina. They are used in several surgical procedures: cardiac, thoracic, spine, abdominal, pelvic, head and neck, and prostate.

Norberto bernardo is a urologist and director of the urology center of argentina.

Norberto Bernardo is a urologist and director of the Urology Center of Argentina.

“In urology, in tumor diseases, it is possible to: remove the prostate in cancer patients; remove the kidney tumor, preserving the function of the remaining organ and remove the bladder to rebuild a new intestine,” Norberto Bernardo, urologist and director of the Argentine Center of Urology, points out in an interview with Clarín.

The road to a new medicine

The contributions of robotic surgery to medicine are of great importance and will continue to increase in the future. It allows for greater precision in the cutting and manipulation of tissues, reducing the risk of damage to the surrounding organs and nerves and avoiding making large incisions in the abdomen, because the robot cuts by 5-inch millimeters.

Additionally, robotic arms can move more fluidly and precisely than human hands, which can reduce surgical fatigue and improve control during surgery.

Robotic surgery: a method that increases surgical precision and is used in a hospital in argentina

“Da Vinci” robot consists of three parts: a console, a car and a tower. Through this technology, the impact of the intervention is reduced on the patient, who suffers less pain and a shorter hospital stay.

Among its benefits is also the fact that, with a minimally invasive surgery, due to the fact that it presents less blood loss and less surgical aggression, the postoperative recovery of the patient is much faster and better. Thus, they allow greater care in the operating room and less hospitalization time for patients. The technique also enables better visualization of the working field.

The tools used in robotic surgery are expensive, but the benefits offered mean that more than 90% of prostate cancer surgeries in the United States are performed using robots.

“In the case of the treatment of prostate and bladder cancer, the functional results are beneficial for the recovery of urinary continence and to support erections,” describes Bernard. The first experience with robotic surgery was at the Cleveland Clinic, in 2002, in an observation granted by the Urology Society of Argentina.

Working with the davinci robot in 2017. Archive / rubén digilio

Working with the DaVinci robot in 2017. Archive / Rubén Digilio

“Since all surgical procedures have risks, robotic-assisted surgery decreases bleeding and the need for transfusions. In addition, it reduces the incidence of pain and possible infections in the postoperative period,” he explains.

What are the benefits of surgery?

Diego Pereyra is a specialist in Intensive Care and Technologist, author of the book “La salud del futuro”. Asked by Clarino, he answers: “Today they are always working in the same room, but with the comfort of sitting and relaxed in an ergonomic position, with the head resting on the cephalic, not having a support that helps to look. rather than suffer muscle contractions or loads to remain in large areas.”

Diego pereyra is a specialist in intensive care and technologist, author of the book "health in the future".

Diego Pereyra is a specialist in Intensive Care and Technologist, author of the book “La salud del futuro”.

Also, this type of surgery allows you to visualize structures in an increased size and in 3 dimensions. In addition, the tools attached to the robot’s arms do not exhibit vibration and require greater precision in the manipulation of structures that must maintain normal operation.

Where are the robot surgeons working in Argentina?

The first experience in Argentina was the Hospital Italiano, in 2008, but robot-assisted surgery is still practiced in a few centers. The Otamendi Sanatorium works with DaVinci version 11, the latest from the intuitive company, and there are also other intuitive units in the Hospital Italiano, Hospital Churruca and Hospital Madariaga de Posadas in Misiones.

For Pereyra, the big problem in Argentina is the cost, because the supplies required for each surgery, valued in dollars, are imported.

“It ends up being cheaper to go for conventional laparoscopic surgery, for example, in which sterile, reusable and readily available materials are much cheaper than buying disposable supplies for robot-operated surgery,” he reasoned.

How and where can exercises with robot surgeons take place?

“In an elite training center to certify medical skills in different parts of the world. It provides an intense and enriching experience from the training. We started the training from February 2021 and in the process of the pandemic. It is a multidisciplinary program that has already exceeded 200 procedures”, distinguishes Bernardo.

The robot allows for precision so that surgeons don't even have to use their hands.

The robot allows for precision so that surgeons don’t even have to use their hands.

In the same vein, Pereyra indicates the practice of surgical robots working in special operating rooms, with doctors using simulators. “There is a pilot driving a ship, it’s an hour of flight. As the pilots go through the simulator calmness, the same happens with the surgeons who work with these robots. The enemies are given conditions, complex scenarios of bleeding, cardiac arrest, among others, so that they can understand how to deal with them in environment of danger and necessity.

How do you train a robot doctor?

Initially, robots were used in the automotive industry and later specifically for use in minimally invasive surgery. They use complex software that allows them to evaluate the effectiveness of each movement.

“The robotic surgeon requires a demanding training process with a progressive learning process for the use of the robotic system, with tests that allow certification that accredit their skills. Connectivity allows working with surgeons located at great distances, using the internet and working with their assistants in the room together with the patient,” explains Bernardo.

The doctor directs the surgery from the booth. Afp photo

The doctor directs the surgery from the booth. AFP photo

Through the layers they carry out sensory movements. They know how to distinguish densities, colors, and fluids when they do not touch any physical structure and when they enter a cavity.

And how is the doctor trained? “They are simulators from manufacturers of robot kits. They are equipment, like a virtual reality or metaverse type: they all teach how to tie a surgical knot to cut, clamp, vascular bundle to cut a nerve, or break a stone into small pieces so that they can remove it. “, Pereyra interrupted.

robotic surgery papers

“Same Day Discharge After Robotic Prostatectomy” is an article published in November 2019 in the Journal of the American Urological Society.

The study evaluated robotic prostatectomy performed on an outpatient basis over thirty-two months in 500 men who underwent consecutive operations. 246 (49.2%) were discharged on the same day as surgery and the remaining 254 were discharged the following day for a mean time of 0.51 days.

“Same-day discharge after robotic-assisted laparoscopic prostatectomy can be offered safely and on demand, with no increase in outpatient visits or emergency visits. It can lead to significant savings in healthcare costs,” Bernard emphasizes.

“We are going to announce the ‘health of the future’, a book in which we propose and control the health challenges that exist in technological matters, for the good of patients and humanity,” says Pereyra.

And he concludes: “We don’t only solve robotic problems, but also, for example, we talk about how the genome can be manipulated: we all know the time of our birth, but we don’t know the time of expiration. I believe that with medical technology, in the future, we will be able to estimate how many years we will have to live.”


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