Robotic/Robot-Assisted-Surgery

WHY IT IS PREFERRED?

Small incision
Less pain
Much less blood loss
Lower risk of infection
More aesthetic appearance
Better and faster recovery

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Robot arms used in robotic surgery have the ability to imitate all movements of the hand by moving 540 degrees. The surgeon controls the camera as well as the instruments and can magnify the image up to at least 10 times if desired.

Robotic surgery or robot-assisted surgery is a surgical method defined as performing some operations through small holes using the “da Vinci Xi” system. After thoracoscopic and laparoscopic surgery following classical surgeries, robotic surgery, which provides a number of conveniences to both patients and surgeons as a new step in minimally invasive surgery, is used for the surgical treatment of many diseases, especially cancer. In this article, we explain how robotic surgery practices are performed, especially in 5 specialties. You will be amazed at the level robot-assisted surgery has reached while reading our article containing the explanations of Prof. Altan Kir, MD. a thoracic surgeon, Prof. Murat Dede, MD. obstetrician and gynecological oncology surgeon, Prof. Hasim Ustunsoy, MD. a cardiovascular surgeon, Ilker Tinay, MD. the Director of the Urooncology Center and Ayhan Demir, MD. a general surgeon at Anadolu Medical Center.

WHY ROBOTIC SURGERY?

Prominent features of robotic surgery

Robots, which we have been accustomed to watching in science fiction movies for years, now bring great convenience to our lives in many areas. The use of robotic technologies, especially in the medical field, is actually a great revolution. It is performed much more successfully through robotic surgery. Robotic surgery, which has various advantages compared to traditional surgical approaches, is now an important reason for preference in appropriate patients and conditions. Robotic surgery, which makes it possible to work with more than one arm at the same time, also allows the practice of normally quite complex or impossible techniques. Its prominent features are:

• Thanks to the camera of the robotic arm, surgeons can see the operating area more clearly and in higher resolution, which increases the success of the surgery.
• Since it is performed through small incisions (minimal surgical method), the probability of developing complications associated with the surgical site is very low.
• Important structures such as nerves and vessels that need to be protected in the operation site are detected more easily with the high-resolution camera of the robotic arm, and the surgeon has the opportunity to examine the operation site more clearly and in depth.
• In the postoperative period, the patient experiences less pain and less blood loss, and the recovery time is accelerated. Only a small scar remains. The length of stay in the hospital is also significantly reduced, so that the patient can be discharged early, and drug treatment can be started early after important surgeries such as cancer surgery.
• Through high-resolution imaging, small tissues and vessels that are perceived by the human eye but cannot be processed can be repaired easily. Since the robotic surgery system is suitable for ergonomic use, it increases the work comfort of the surgeon in long surgical procedures and positively affects the success of the surgery.
• Since more accurate and clear surgical repairs can be made in robotic surgery, much more positive results are obtained in terms of functional and cosmetic aspects.

HOW IT IS PERFORMED?

Of course, one of the most wondered aspects about robotic surgery is how it is performed. In robotic surgery, the surgeon performs the operation by controlling four robotic arms with the help of a console. Robotic arms function as cutter, gripper, burner and retractor. Internal images of the body are followed by the surgeon on the console in 3D. With the robotic arms on the patient, a second surgeon is present at the bedside to deliver the necessary instrument to the robotic arms. The surgeon performs the operation by means of a console located 3 to 4 meters to the patient. The two arms of the console have been developed in a way that the surgeon can use the 4 arms on the patient.

One of the four arms on the patient is the camera, the second and third arms act like the surgeon's right and left arms, and the fourth arm is used to remove the tissues that may interfere with the surgeon (retraction). It is possible for the surgeon to immobilize any arm in any way, as well as to hold the arms without moving, to move them 540 degrees in a way that a human hand cannot and to eliminate the tremors in the human hand.

5 SURGICAL FIELDS THAT ROBOTIC SURGERY IS MOST COMMONLY USED!

1 THORACIC SURGERY

Prof. Altan Kir, MD. a thoracic surgeon at Anadolu Medical Center, says “The most important reason for preferring robotic surgery in lung cancer is that it allows easier and more precise removal of lymph nodes”.

Robotic surgery is a frequently used method, especially in patients with lung cancer. Whether it is benign or malignant, it is possible to benefit from robotic surgery in operations where a segment of the lung, a lobe or the entire lung must be removed, esophagus surgeries, mediastinal cysts and tumors, loose diaphragm or its paralysis.

In lung cancer surgeries, the lymph nodes around the bronchi and mediastinal lymph nodes must be removed. Because the presence of metastasis in the removed lymph nodes is important for the staging of the disease. One of the most important reasons of why robotic surgery is preferred in lung cancer is that it allows easier and more precise removal of lymph nodes. Thus, we obtain information about whether additional treatment, namely chemotherapy and/or radiotherapy, is required and how the disease will progress.

2 GYNECOLOGICAL SURGERY

Prof. Murat Dede, MD. an obstetrician and gynecological oncological surgeon at Anadolu Medical Center, says “Robotic technology offers the ability to suture comfortably in the abdomen by rotating the instruments as much as a wrist cannot”.

In gynecological surgery, most of the extremely serious gynecological surgeries such as cancer surgeries, removal of the uterus, removal of large myomas, correction and reconstruction of genital prolapses, tubal reanastomosis (making the tubes work again after tubal ligation) can be performed using a robotic surgical system. Robotic technology offers the ability to suture comfortably in the abdomen by rotating the instruments as much as a wrist cannot. Detailed images obtained by magnifying the tissues by 10 times are a great comfort for the surgeon.

3 GENERAL SURGERY

Ayhan Erdemir, MD. a general surgeon at Anadolu Medical Center, says “As in all other procedures, robotic surgery systems provide additional benefits to both doctors and patients in selected general surgery operations”.

General surgery is one of the fields in which robotic surgery systems are widely used. As in all other procedures, robotic surgery systems provide additional benefits to both doctors and patients in selected general surgery operations. As in other surgeries using Da Vinci Xi, the incision is less in general surgery procedures, and accordingly, the shortening of pain, bleeding and recovery times are among the positive benefits for patients. However, the main benefit is to see the deep tissues that are difficult to reach and hard to see with traditional methods more easily and to perform the necessary operations in more detail and flawlessly manner.

Colon and rectum surgeries are at the forefront of the surgeries in which the robotic surgery system is used most successfully. There are many surgical procedures that can be performed using the Da Vinci robot in general surgery:

• Colon and rectum diseases, in particular their cancers
• Gastric and esophageal diseases
• Pancreas diseases
• Spleen diseases
• Liver and biliary tract diseases
• Some endocrine organ diseases, especially the adrenal gland

4 CARDIOVASCULAR SURGERY

Prof. Hasim Ustunsoy, MD. a cardiovascular surgeon at Anadolu Medical Center, says “Robotic surgery is safely performed in mitral valve replacement and repair, tricuspid valve replacement and repair, ASD closure, VSD, PDA and heart tumors”

Robotic surgery also creates great comfort for cardiovascular surgery. Performing surgery through small incisions without opening the thorax becomes possible. In this way, there is less blood loss, lower risk of infection, less pain, a more aesthetic appearance and a very comfortable and faster recovery time. In this sense, the patient can return to daily life more comfortably in almost one quarter of the normal heart surgery recovery time.

Robotic surgery is performed for mitral valve replacement and repair, tricuspid valve replacement and repair, ASD closure, VSD, PDA and heart tumors.

Using robotic cardiovascular surgery, in patients with by-pass, the heart is reached through a 3-millimeter hole opened on the left side of the chest and a small incision of approximately 3 to 4 cm. In cardiac valve surgeries, removal of some cardiac tumors and closing of some heart holes, the operation is performed following 4 millimetric holes and a small incision of 4 cm on the right side of the chest. In the case of the heart vessels, we can replace whole vessels either using a heart-lung machine or one or two vessels without using a heart-lung machine and without stopping the heart.

5 UROLOGICAL DISEASES

Ilker Tinay, MD. a urologist and the Director of the Urooncology Center at Anadolu Medical Center, says “The most common and most successful use of robotic surgery in urology is radical prostatectomy, which is the surgical treatment of prostate cancer”.

Urology is one of the most widely used areas of robotic surgery. The most common and most successful use of robotic surgery in the world, whose frequency of use is increasing thanks to the benefits it provides to the patient and the physician, is radical prostatectomy, the surgical treatment of prostate cancer, one of the most common cancers in men. In addition, it has many areas of use in urooncology: Removal of the tumoral part for kidney cancers, radical cystectomy and neobladder construction for bladder cancers, total removal of kidney and ureter for upper urinary system cancers, removal of retroperitoneal masses for testicular cancers, correction of ureteropelvic stenosis, removal of sacs formed in the urinary bladder and some surgeries performed for bladder prolapse in women.