Minimally invasive surgery
da Vinci robotic surgery
Elvira Bratila. MD, PhD – the first gynaecology surgeon to have carried out robotic surgery interventions in Romania: “Medicine is a field that evolves each year, by new technologies, new techniques and surgical approaches, by an accelerated scientific and technological dynamics. No new step is easy to assimilate in medicine. When I had access to robotics, I wondered how I could put this robot into the service of people, of our patients, and with each new intervention, I wanted to bring in an additional benefit, by a superior surgical act. Which appealed to me the most in robotic surgery was the “intuitive” way in which the Da Vinci robot integrated into the surgical team as a team member, as a “helping hand” brought into the operating room. The results of the robotic surgery certainly constitutes a progress in our field, and its addressability is very wide in complex interventions: surgery of gynaecological cancers, endometriosis surgery, urogynaeocology, as well as in interventions for benign pathologies, which we are frequently confronted with, such as the surgery of uterine fibroids.”
The advantages brought by robotic surgery into the medical act:
Robotic surgery used in gynaecology is a great step ahead for the progress of the gynaecology field, for the advantage of patients who benefit from this state-of-the-art technology and have a hasty post-surgical recovery. The surgical act is atraumatic, without any perioperative pain or complications and, thus, the patients have the possibility to be rapidly reinserted in their social and professional life.
The da Vinci surgical system is a sophisticated robotic surgery platform, which was designed to amplify and extend the surgeon’s capabilities. During surgery, the robot facilitates the handicraft and flexibility of the human gesture by robotic gestures.
During surgical intervention, the abdominal wall is no longer cut, just four small incisions are made instead, which make possible a faster postoperative recovery. Four specially designed are inserted through these incisions, in order to reduce trauma in the abdominal wall and postoperative pain. Through these trocars there are introduced the work miniaturized instruments and a high definition 3D camera.
The Da Vinci surgical system consists of 3 separate components: the surgeon’s console, the vision cart (which is positioned over the patient and holds the 4 robotic arms – three different instruments and a high definition 3D camera) and the control tower (a computer which integrates the information sent by the surgeon’s console, the camera and the 3 robotic arms).
The 3D vision of the operating field allows for a superior clarity for the visualisation of the anatomy (up to 10x magnification) and the evaluation of endometriosis lesions. Another advantage of this system is that it allows for changing the camera on any of the 4 trocars (in the event that there are deep lesions in the pelvis that cannot be efficiently visualised due to the distortion of the anatomy), unlike the open surgery (by a wide incision on the abdomen) where the surgeon, although he has a good visual access, he has only digital access to the deeper areas of the pelvis. In robotic surgery, the 3D camera has access to deep areas of the pelvis, which offers the advantage of magnifying the image by up to 10 times. For this reason, the surgical gestures are more secure, because in these spaces there are vascular and nervous structures that must be protected (nerve sparing) in order to ensure a good quality of life after the surgical intervention.
How a robotic intervention unfolds
1.The surgeon operated standing in the same room with you, at the da Vinci console, watching the high-resolution 3D images inside your body, enhanced up to 10x.
The 3Dimages allow the surgeon to visually observe anatomic structures in HD format and in natural colours, with an impeccable visualisation of the surgically explored region.
2.In order to operate, he uses the manipulators, which function as clamps. When the surgeon handles the manipulators, the da Vinci system responds in real time to the signals received from the console, by transmitting the hand movements into precise movements of the miniaturised instruments (EndoWrist) from the cart placed beside you.
3.The patient’s cart may support up to three EndoWrist instruments and a 3D camera. In order to have access to the anatomic area targeted, the surgeon introduces in your body the EndoWrist instruments through 1-2 cm incisions. The system gives the possibility to carry out 540° movements – which are impossible for the human hand, in order to intervene in hardly accessible positions and places.
4.The surgeon has at his disposal a wide range of instruments to help him execute the surgical manoeuvers with high precision and control, and a freedom and speed of movement that are much greater than those of the human hand. The console allows for a natural hand-eye positioning, a comfortable seated position, and the incorporated microphone facilitates the effective communication in the operating room.
Advantages of surgeries done by aid of the da Vinci robotic system for the patients:
- surgical precision;
- lower risk of major complications;
- diminution of risk of infections;
- reduction of blood loss;
- significantly less postoperative pains;
- smaller and less numerous scars;
- fast recovery;
- reduced hospitalization period.
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