Successful surgical premiere: Associate Professor Dr. Denis Ehrl at the joysticks of the Da Vinci robotic system. It has now been used for the first time in plastic surgery at the LMU Hospital for a major procedure on a cancer patient. © Team Ehrl-Karcz/LMU Klinikum
In plastic surgery, specialists at the LMU Hospital have used a surgical robot for the first time – the surgical premiere was a success. Other cancer patients are expected to benefit from the technology.
The patient swallowed first when he learned of the doctors' plan: They had to remove a huge soft tissue tumor on the back of his head, this so-called sarcoma measured about 15 by 15 centimeters. In order to close the hole in the tissue afterwards, the plastic surgeons at the LMU Hospital transplanted a back muscle onto his head. More precisely, the latissimus. "This is the largest muscle in the body. Everyone has two of them, they run to the left and right of the spine," explains PD Dr. Denis Ehrl (40), deputy director of the department.
In conventional surgery, a 40-centimeter-long skin incision is necessary
What sounds almost scary to laymen is standard for experts like Ehrl. The strategy of using the latissimus to cover defects, as it is called in technical jargon, has proven itself for decades. For two main reasons: On the one hand, you can live with only one of these two back muscles without major restrictions, and on the other hand, it is ideal for transplantation. "Essentially, it is only supplied with blood through one main vessel, which makes it relatively easy to separate from the vascular system and sew it back on," explains Ehrl. However, in a conventional operation, the specialists have to make a skin incision about 40 centimeters long in order to remove the muscles.
High-tech in the operating room: Associate Professor Dr. Denis Ehrl controls the robot with joysticks. On the screen you can see the robotic arms in the patient's body. The operating table is a few meters away. © LMU Kllikum/Team Ehrl-Karcz
Robot enables surgery with much smaller incisions
With the help of the robot, the plastic surgeons were able to spare their patient this giant incision. Instead, they now had two accesses about one centimeter in size to insert the robotic arms into the body, as well as an opening about six centimeters long to "recover" the muscle. "The smaller cuts make a huge difference. As a result, the removal of the muscle is much gentler for the patient, and healing is accelerated," reports Ehrl.
Surgeon Ehrl controls the delicate robot arms with joysticks
During robotic surgery, its delicate and movable arms work practically under the skin. They are controlled by the surgeon with joysticks, while he sits several meters away from the operating table and looks intently into a monitor. His assistants stand directly next to the patient and monitor the procedure. The decisive factor here is that the robot does not make a single stroke on its own, the doctor is in control of the procedure at all times.
The Da Vinci robot system is considered a classic among surgical robots and is constantly being technically retrofitted. Now it is also used in plastic surgery to operate more gently. © Denis Ehrl/LMU Klinikum
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The Da Vinci robotic system has already proven itself in other medical specialties
At the surgical premiere in plastic surgery, the LMU specialists used the established Da Vinci robotic system. It has proven itself in other medical fields for many years and has been technically refined again and again over the years. "Originally, Da Vinci was developed for heart surgery. But many patients are familiar with it from urology and visceral surgery, where it is used very successfully for operations on the prostate or intestine, among other things," reports Professor Konrad Karcz, head of the working group "Minimally Invasive Surgery/Surgical Technological Innovations" at the LMU Hospital. The intensive preparation was also made possible thanks to the support of the two heads of plastic surgery and urology, Prof. Riccardo Giunta and Prof. Christian Stief.
Robot specialist Karcz as coach
Because abdominal surgeon Karcz (50) has a lot of experience with the Da Vinci robot, he practically assisted his colleague Ehrl as a coach. Before the surgery premiere, the plastic surgeon spent hours training every single step of the process in simulations. In the case of his cancer patient Mirbagir, Ehrl was also assisted by colleagues from neurosurgery. Because the tumor had grown into the skull, they had to remove part of it and replace it with artificial bone.
Overjoyed: Cancer patient Mirbagir (64; 2nd from the right), flanked by his nephew Ramil (35; 2nd from left.) and his physicians Privatdozent Dr. Denis Ehrl (right) and Professor Konrad Karcz from the LMU Klinikum © Andreas Beez
Patient (64) from Ukraine has been fighting cancer for 25 years
Despite the great hardships, the patient recovered surprisingly quickly. Just a few days after the procedure, the 64-year-old Ukrainian was allowed to leave the hospital after just a few days, and only a few weeks later the healing process of the wound has progressed well. "I have been fighting this cancer for 25 years and have already been operated on several times. But recently, the tumor had grown considerably. I am glad that it could be removed so well and grateful to the great doctors at the LMU Hospital for my new life," says Mirbagir.
Nephew reports: "His eyes sparkle again, they are full of life"
The whole family is overjoyed that the 64-year-old is doing well again – especially since she recently had to cope with a heavy blow of fate. Mirbagir's son died of a heart attack at the age of only 35, and his father is also married by his three other children and six grandchildren. Mirbagir's successful treatment has shed some light on the family's everyday life. "The little ones in particular are happy that they have their grandpa back and can play with him," says Mirbagir's nephew Ramil (35). "Despite our grief for my cousin, we are all happy that he is back with us. When he romps around with his grandchildren, you can see a sparkle in his eyes again. They are full of life."
