Enrique Rivero is 66 years old and suffered from prostate cancer.
In 2021, he underwent surgery in which that organ was completely removed.
The peculiarity is that a
robot surgeon
, the DaVinci XI, intervened in the operation.
“I had no pain or felt any discomfort.
The recovery was very fast.
I was hospitalized for 48 hours.
On the second day I was able to walk back to my house.
I was surprised because I thought that the hospitalization was going to take much longer, ”he describes, incredulous and satisfied with the result.
The intervention is called "robotic radical prostatectomy" (complete 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 healthcare, they revolutionized the way of diagnosing, treating and even preventing certain diseases.
Surgeon robots assist the surgeon, who is seated at the command console, to perform highly precise and complex procedures on the operating table, where a multidisciplinary team intervenes.
They already work in some clinics in Argentina.
They are used in multiple surgical procedures: cardiac, thoracic, spine, abdomen, pelvis, head and neck, and prostate.
Norberto Bernardo is a urologist and director of the Argentine Center of Urology.
“In urology, within tumor diseases, it is possible to: remove the prostate in cancer patients;
remove a kidney tumor, preserving the rest of the functioning organ and remove the bladder to reconstruct a new one using the intestine”, points out Norberto Bernardo, urologist and director of the Argentine Center of Urology, in dialogue with
Clarín
.
The path to a new medicine
The contributions of robotic surgery to medicine are very important and will increase even more in the future.
Allows for greater precision in incision and tissue manipulation, reducing
the risk of damaging surrounding organs
and nerves and avoiding having to make large incisions in the abdomen because the robot penetrates through
small 5-inch cuts millimeters
.
Additionally, robotic arms are able to move more fluidly and precisely than human hands, which can reduce surgeon fatigue and improve control during the operation.
The "Da Vinci" is a robot made up of three components: console, car and tower.
Thanks to this technology, the impact of the intervention on the patient is reduced, who experiences less pain and a shorter hospital stay.
Among its benefits it also redounds that, being a minimally invasive surgery, due to the fact that it presents less blood loss and less surgical aggression, the recovery of the postoperative patient is much faster and more satisfactory.
Thus, they allow greater precision in operating rooms and
less hospitalization time
for patients.
The technique also enables better visualization of the area of operation.
The instruments 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 treatment for prostate and bladder cancers, the functional results benefit the recovery of urinary continence and help maintain erections”, Bernardo describes.
His first experience with robotic surgery was at the Cleveland Clinic, in 2002, during an
observership
granted by the Argentine Society of Urology.
An operation with the DaVinci robot in 2017. Photo Archive / Rubén Digilio
“While 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 illustrates.
What are the benefits for the surgeon?
Diego Pereyra is a specialist in Intensive Care and Technologist, author of the book
"The health of the future"
.
When asked by
Clarín
, he answers: "Today, they are always in the same operating room, but with the comfort of being seated and relaxed in an ergonomic position, with their heads resting on a cephalic support that helps them look, without having to than suffer muscle contractures or overloads from staying in forced positions”.
Diego Pereyra is a specialist in Intensive Care and Technologist, author of the book "La salud del futuro".
Even this type of surgery allows them to visualize the structures in an enlarged size and in 3 dimensions.
In addition, the instruments attached to the robot arms
do not present tremor
and offer greater precision in the manipulation of structures that must maintain their normal operation.
In which clinics in Argentina do robot surgeons work?
The first experience in Argentina was that of Hospital Italiano, in 2008, but robot-assisted surgery is still performed in few centers.
The Otamendi Sanatorium works with the XI version of DaVinci, the latest from the Intuitive company, and there are also other Intuitive units at Hospital Italiano, Hospital Churruca and at Hospital Madariaga de Posadas in Misiones.
For Pereyra,
the big problem in Argentina is the cost
because the supplies required for each surgery are valued in dollars, they are imported.
“It ends up being cheaper to go for a conventional laparoscopic surgery, for example, in which the sterile, reusable and disposable materials used are considerably cheaper than buying the disposable supplies for a surgery operated by a robot”, he reasons.
How and where can practices be done with robot surgeons?
“In selected training centers to certify the surgeon's skills in different parts of the world.
It is an intense and enriching experience due to the training it provides.
We started the practice from February 2021 and in the course of the pandemic.
It is a multidisciplinary program that has already exceeded 200 procedures”, distinguishes Bernardo.
The robot allows a precision that not even the wrists of surgeons have.
In the same vein, Pereyra points out that the practices with robot surgeons are done in specialized operating rooms, with
doctors using simulators
.
“It's like a pilot driving an airplane, it's hours of flight.
Just as the pilots go through a simulator to be calm, the same happens with the surgeons who operate with these robots.
They are given hostile situations, complicated scenarios of bleeding, cardiac arrest, among others, so that they can figure out how to deal with them in a context of risk and urgency."
How do you train a robot surgeon?
Initially, the robots were used in the automotive industry and were later specifically designed for use in minimally invasive surgery.
They use complex software that allows to evaluate the efficiency of each movement.
“The robotic surgeon requires a demanding training process with progressive learning of the use of the robotic system, with exams that allow a certification that accredits their skills to be granted.
Connectivity allows operating with the surgeon located at great distances, using the internet and with his assistants in the operating room together with the patient”, explains Bernardo.
A doctor directs a surgery from a booth.
AFP photo
They train through layers, with movement sensors.
They know how to distinguish densities, colors, liquids, when not to touch any physical structure and when to enter a cavity.
And how is a surgeon trained?
“There are simulators offered by the manufacturers of these robot kits.
They are equipment, as if they were virtual reality or
metaverse
type : they teach everything from how to tie a surgical knot to how to cut, clamp, cut a nerve vascular package, or break a stone into small pieces to be able to remove it”, Pereyra develops.
robotic
surgery
papers
“Same Day Discharge After Robotic Prostatectomy” is an article that was published in November 2019 in
the American Urological Association
Journal of Urology.
The study evaluated the performance of robotic prostatectomy on an outpatient basis for 18 months in 500 men who underwent consecutive operations.
246 (49.2%) were discharged the same day as surgery and the remaining 254 were discharged the following day, for a mean length of stay of 0.51 days.
“Same-day discharge after robotic-assisted laparoscopic prostatectomy can be offered safely and routinely, with no increase in readmissions or emergency visits.
It can lead to significant savings in healthcare costs,” Bernardo emphasizes.
“We are about to publish
“The health of the future”
, a book in which we propose and put in check the health challenges that exist in technological matters, for the good of patients and of humanity”, says Pereyra.
And he concludes: “We not only analyze robotics issues but also, for example, we talk about how the genome can be manipulated: we all know our date of birth, but we don't know the date of expiration.
I believe that with medical technology, in the future,
we will be able to estimate how many years of life we are going to live
”.
MG
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