“Center of Excellence”
ROBOTIC SURGERY for the surgical treatment of our INTERNATIONAL PATIENTS
The surgical application of robotic systems is one of the most exciting and significant technological developments of this century; its future implications are incalculable.Huge strides have been made in the field of closed operations in the past 10 years and the use of robotic systems has emerged as the principle solution to technical limitations.
Group Florence Nightingale is proud to be a regional leader in the field of robotic surgery. This information has been prepared for our International Patients in order to provide more detailed knowledge and perspective about the techniques available to our International Patients through ourdedicated CIP department.
The use of robotic surgical systems has numerous advantages. Whereas modern laparoscopic systems give only a two-dimensional vision, robotic systems give the surgeon a three-dimensional field of vision and depth, provide arms that, unlike the human hand, never tire and permit an unprecedented continuityin operations. Since robotic systemsexceed even the human hand’s freedom and facility of movement, far greater delicacy and dexterity is achieved.
Modern robotic surgical systems
Modern robotic systems fall into three categories; active, semi-active and master-slave. The first two categories offer degrees of artificial intelligence and autonomy to the surgeon, but the most commonly used are master-slave systems distinguished by the surgeon’s absolute control of the robot via a remote control console. These systems were first developed by NASA for remote treatment of astronauts in space and the first “da Vinci” TM robotic system gained regulatory approval in the US in 2000.
Da Vinci TM roboticsurgical systems
As shown in image 1, the da Vinci system consists of a robotic tower (comprising binoculars, optic camera and 3 robotic arms), and surgeon’s console giving high definition 3D vision of the operation area and the control area for the three robotic arms.
da Vinci S Robotic System
As shown in image 2, the binoculars offer 3D vision with actual field of depth for the control hands (left) through the binocular optics (right)
Applicationsof Robotic Surgery Today
Robotic technology began to be applied in 1994, mainly in cholecystectomy, varicose vein and bladder suspension surgery. Its first widespread clinical application was in Europe where 146 patients were operated on using the da Vinci robot between 1997 and 2001, including two radical prostatectomy and a varicocelectomy operation, in which no robot system related complications were observed at all and the computer and imaging systems were confirmed as fully functional. Further applications in the US during these years expanded da Vinci’s field into donor nephrectomy operations and confirmed robotic surgery’s practical usage and viability in parallel with standard laparoscopy.
These developments expanded application in general, thoracic, orthopedic, pediatric and urological surgery. In urology, principle applications are as follows: radicalprostatectomy, pyeloplasty,psoashitch, boariflap, ureteralreimplantation, radicalcystectomy, ilealneobladder, donornephrectomy, adrenalectomy, radicalandsimplenephrectomy, partialnephrectomy and sacrocolpopexy.
Robot-Assisted Radical Prostatectomy
This is the field in which robotic surgery has been most widely applied since first used in Germany and the US in 2000. Radical prostatectomy requires highly delicate and detailed dissection and stitching, perfectly suited to the da Vinci instruments’ six degrees of freedom in movement: their ability to revolve on their own axis through 5400 facilitates movement in narrow and restrictive areas such as the male pelvis to a remarkable degree (Image 3), allowing easy achievement of fine and detailed dissection in operations protecting the neurovascular bundle with the assistance of the robot’s filtered 3D imaging and movements. The instruments’ ability for easy and precise movement also facilitates seepage-free operation in the highly challenging area of urethra and bladder anastomosis.
The robotic instrument showing six-degree movement and 5400 rotation.
With all these advantages, the use of robotic surgery in radical prostatectomy operations has expanded at breathtaking speed in recent years. In the US, 2,648 such operations were carried out in 2003, rising to some 55,000 in 2007, by which time 65% of radical prostatectomyoperations were carried out robotically.
Minimally Invasive Robotic Surgeries
