DA VINCI ROBOTIC SURGERY IN GENERAL SURGERY RELATED SURGERIES
Surgeries performed with a small incision “minimally invasive” surgeries, are preferred primarily in cancer treatments as is the case in many other area nowadays.
These technologies, which are used today, are considered as the most important development in modern surgery and offer many privileges to patients and physicians in comparison to classical open surgery.
Thanks to minimally invasive methods, the most difficult surgeries are performed in a way to provide comfort to the patient due to surgical and technological developments.
Robotic surgery, which is considered as the most advanced technology in the last 10 years among the minimally invasive surgeries, is being used in general surgery, especially in cancer surgeries.
The da Vinci Robotic System is the most advanced surgical technology of our age, controlled by the surgeon, achieving the deepest points during surgery, with a 3-dimensional and clear image, providing multi-angle mobility with robotic arms and without the slightest shaking. The da Vinci Robotic System enters through the small holes opened into the abdominal wall of the abdomen, displaying the deepest organs within the body under 10-fold magnification and in high-resolution with three-dimensional imaging. It enables the surgeon to control the surgery via robotic arms with 7 sizes and thin-small surgical instruments on the tips thereof within the body of the patient.
The “da Vinci Robotic Surgery” provides comfort to the patient
• It does not require a large surgical incision as is the case in open surgery. The process is performed through small holes.
• The surgery is performed with 10 times larger and clearer images.
• The image quality is high resolution and three-dimensional. Thanks to the 3-D image, depth advantage is ensured.
• It is easy to position with small robotic arms that do not shake and move at 720 degrees .
• The presence of vessels and nerves is clearly imaged.
• It is a more successful method compared to open surgery in tumor operations.
• Bowel activities return to pre-op conditions much faster.
• The nutrition of the patient returns to normal faster than in open surgery.
• The risk of infection at the surgical site is low.
ROBOTIC TECHNOLOGY IN CANCER SURGERY
Upper Gastrointestinal System
The da Vinci Robotic System, which has been developing rapidly all over the world since 2001, is becoming increasingly popular nowadays. Interventions can be performed more conveniently and safely with superior tissue separation suturing techniques of the da Vinci Robotic System for upper gastrointestinal surgery.
• GERD (Reflux Surgery)
• Hiatal Hernia
• Stomach and Stomach Cancer
• Achalasia (Esophagus lower tip narrowness)
Small Intestine Surgeries
Use of Robotic System; It is important because of the procedures applied to the patient and the ability of the surgeon to facilitate their interventions. It enables the surgeon to perform thinner tissue separations and more comfortable sutures by providing more detailed monitoring of vessels and nerves. It provides the opportunity to adhere to the principles of cancer surgery. It facilitates the approach to the tissue by providing 3D (three-dimensional) appearance, with more features than laparoscopic cameras. This enables the surgeon to see more and move more in areas that are difficulty in open surgeries.
• Narrowness of small intestine (due to Crohn’s disease)
• Small intestine tumors
Robotic Surgery Center
Da Vinci Robotic Surgery or also known as robotics, is the most advanced technology in the medical world and is especially used in Turkey, especially in major centers in the US, including the departments of urology, gynecology, general surgery, otorhinolaryngology, thoracic surgery and cardiovascular surgery. The “da Vinci Robot Technology” stands out as a technology with special privileges it provides to the physician and the patient and is today one of the most successful surgical methods used in the fight against cancer all over the world. The robot assisted laparoscopic surgery method, shortly known as “robotic surgery” has three main characteristics. The first of these are the imaging systems, which work with the principle of laparoscopic surgery. So the image is transferred through the body of the patient to the surgeon with the help of a camera. In contrast to laparoscopic surgery, in robotic surgery this image is three-dimensional and since the camera control is performed by a robot, the image is steady. Clear images can be obtained at a larger magnification by approaching the organ to be operated very closely. The surgeon controls the robot arms using a console. These robot arms are placed in the patient. Fiber optic cables in the console extend to the arms of the robot and transfer the small hand movements made by the surgeon to the robotic arms. Surgical instruments connected to the robotic arms can rotate 540 degrees so that they can move much more than hand movements. In addition, the natural shivering in the hands of a human is not conveyed to the tips of the surgical devices in robotic surgery. In this way, the margin of error is also minimized.
LAPAROSCOPIC AND ROBOTIC SURGERY IN PANCREAS CANCER SURGERY
Pancreatic cancer is the most dangerous cancer within intra-abdominal cancers. The frequency is increasing and in recent years, quite extensive studies are carried out. It is the location of the organ that makes pancreatic cancer more important than other types of cancer. The pancreas, which plays a very important role in the body, is difficult to intervene surgically. Therefore, the term “untouchable” is usually used for the pancreas.
Pancreatic Cancer Treatment Process
If the patient is diagnosed with pancreatic cancer via MRI or tomography, a biopsy should be performed to determine if the diagnosis is definite. If a mass is detected and the patient has complaints such as jaundice and weight loss, the diagnosis is probably correct. Endoscopic biopsy may be necessary in suspected cases. The most important stage of treatment is surgery. Whether the patient’s tumor will be surgically removed is determined by staging. If no metastasis is present in the liver or other organs and the involvement of large vessels is not severe, the patient is operated first. Additional treatments are planned according to the patient’s condition after the surgery. In patients with no chance of surgery, chemotherapy is administered first. In the case of regression of the tumor with drug treatments, it is reassessed whether the patient can be a candidate for surgery. In case of metastasis of pancreatic cancer to many foci and distant organs in the body, first of all, chemotherapy and then alternative treatment options are discussed. The most important point that should not be considered in pancreatic cancer is that the behavior of the tumor varies from person to person as is the case in every cancer type. Therefore, each patient has a chance of treatment and these options should be investigated.
Current Surgeries in Pancreatic Cancer Surgery
In recent years, the most important development in pancreatic cancer surgery is the use of minimally invasive methods, these being laparoscopic and robotic surgeries. The laparoscopic surgery is also performed in patients with pancreatic cancer by entering through a few holes with special tools without causing a large incision on the body. Laparoscopic surgery; if the location of the pancreas tumor is in the trunk or tail, this surgery modality should be primarily considered. In pancreatic head tumors, if the tumor is detected at an early stage, there is no uptake in the main vein and the patient’s age is appropriate, laparoscopic surgery can be performed.
In pancreatic cancers, robotic surgery provides the following important privileges to the patient and the physician;
• Robotic surgery offers the advantages of open surgery and laparoscopic procedures.
• With robotic surgery, cancer can be better controlled.
• It decreases the risk of infection during the surgery and increases the chance of survival of the patient as it does not cause major surgical incisions on the body.
• During surgery, vessels, lymph nodes and other formations are better displayed, which increases the chance of surgery.
• The spleen can be protected during surgery.
• After surgery, the intestines begin to work earlier, the patient feels less pain than in open surgeries, the patient can be discharged from the hospital in a shorter time and will recover and return to normal life faster. The absence of incisions or large scars on the body provide a better cosmetic result to the patient.
Treatment Alternatives in Metastatic Pancreatic Cancers
Pancreatic cancer most frequently metastasizes to the liver. Patients with this type of disease usually display late symptoms, the tumor is located in the trunk and tail of the pancreas. Surgery should not be considered as a treatment option to provide rapid response to the patient. Only patients whose biopsy results or radiological images have been identified as neuroendocrine tumors can be treated and treated quickly. The treatment for patients with metastatic pancreatic cancer is chemotherapy. However, chemotherapy treatment should also be performed after the patient’s condition has been evaluated and the response is predicted.
NERVE PROTECTION IN PROSTATE CANCER SURGERIES
Following prostate cancer surgery, which is the most common male cancer occurring especially in men over 50 years of age and developed in countries other than skin cancer, sexual dysfunction and urinary incontinence problems, which are the two most important risks negatively affecting the social life of men, can be observed. These risks, which can negatively affect the patient’s quality of life, are minimized in prostate cancer surgeries performed via the “da Vinci Robotic Surgery” technique. The erectile nerves and the urinary retention muscles adjacent to the prostate and leading to the penis are much better protected via robot technology. Thanks to this qualified protection, the risks of urinary incontinence and the risk of penile erectile dysfunction are minimized. With the “Intrafacial Nerve Protection” technique applied via robot surgery, the risk of experiencing sexual activity problem after a surgery is minimized.
The privileges which the da Vinci also provides to the patient in prostate surgery:
• The length of hospital stay after the da Vinci Robotic surgery is 1 or 2 days. Approximately 95% of the patients have been discharged home on the second postoperative day.
• Only very small blood loss is present during surgery compared to traditional open surgery. Preoperative blood preparation is not required.
• In the hospitalization period and after leaving the hospital, very little pain relief is required. This is because the patients do not feel pain.
• In the first week after surgery (approximately 4 or 6 days later), a catheter is placed into the urethra. In open surgery, this period usually ranges from 14 to 31 days.
• Approximately 90% of patients return to their routine work with or after 3 weeks of operation with da Vinci Robotic Surgery.
KIDNEY PROTECTIVE EFFECT IN KIDNEY TUMOR OPERATIONS
In kidney tumor surgeries performed via the da Vinci technique, cancer control is provided in the best possible way. Only the tumor tissue is removed and the healthy kidney is left in the patient. Under the three-dimensional and high-resolution enlarged image with robot technology, the tumor is easily removed from the kidney by performing depth calculation in the tissue. The area where the tumor emerges can be sutured quickly and with depth control. After the removal of the tumor tissue, the resulting tissue cavity, opened veins and injured urinary channels are repaired extensively and rapidly by using robotic arms. This method can be performed for the removal of the kidney in large-scale kidney cancer.
TESTICULAR CANCER SURGERY VIA 4 HOLES WITH ROBOTIC SURGERY
Testicular cancer operations are based on the principle of opening up the abdominal wall between the pelvis, removing the intestines and cleaning the lymph nodes around the large vessels starting from the lower end of the bone called sternum, this can be performed via a few holes completely closed with robot technology. The large incisions required for the open surgery of patients with testicular cancer have become history, thanks to the comfort provided by the robotic surgery that provide the patients with great privileges.
Testicular cancer surgeries performed with da Vinci Robotic Surgery;
• Pain, infection and wound healing risks in large incisions decrease with robotic surgery.
• The patient’s intestines are not removed as in open surgery. Therefore, the risk of infection and drying up of the intestines is eliminated.
• Some neural structures that have an effect on sexual functions that are located around the aorta or large vessels can be observed more clearly with the robotic surgery technique. These can be protected more effectively. Therefore, less problems arise related to semen discharge.
• Since chemotherapy may have long-term side effects, robotic surgery may provide advantages in certain patient groups.
• Difficulties to be experienced in post-operative patient regarding becoming pregnant can be eliminated; sperm obtained from the patient before the operation can be stored in a sperm bank and be used for assisted reproduction techniques.
ARTIFICIAL BLADDER FROM THE INTESTINE VIA da VINCI
In developed countries; bladder cancer, which is ranking 4th in men and 7th in women, is treated with da Vinci Robotic Surgery without creating a surgical incision on the body. In open bladder cancer operations; at a point starting 4-5 cm above the belly, the bladder and lymph nodes are removed with an incision extending to the pelvic bone, and the bladder made from the intestine is also connected to the normal urinary tract. In addition, patients who have their bladder removed may have problems such as carrying bags continuously in their bellies or using urethral catheter at regular intervals. In bladder cancer operations performed with da Vinci Robotic Surgery, two different principles are applied. First; After the removal of the bladder and lymph nodes with the robot, the procedure of the new bladder creation from the intestines is performed via an open method and the operation is completed. However, a large incision is required for this surgical technique and since the intestines are taken out of the body, problems such as infection, drying, fluid and heat loss may occur. Bladder cancer operations are performed in a completely closed manner which is a technique used only by very few centers and surgeons around the globe. The operation consists of removal of the bladder, removal of the lymph nodes around the large vessels, bladder reconstruction from the intestines, connection of the urinary canals to this new bladder and the normal urethra connection, after which the surgery is completed in a completely robotic technique.
The privileges provided by the robot in bladder cancer surgery;
• With Da Vinci Robotic Surgery, the patient avoids a very large surgical incision. Surgery can performed via only 6 holes of 8-15 millimeters each.
• Incision hernias may be observed in open surgery incision, the incision sutures may rupture and another surgery may become necessary; all the complications are eliminated vi da Vinci Robotic Surgery.
• Because of the robotic method, the possibility of bleeding during surgery decreases.
• As the patient is operated without opening up the patient, the risks such as drying of the intestines, infection and heat loss are significantly reduced.
• After surgery, patients can recover in a shorter time and return to their normal lives.
• In bladder cancer surgery, the bladder and prostate are removed together. This is because in one-third of patients with bladder cancer, prostate cancer may develop as well while the patients are unaware of this. During extraction of the prostate, the sexual function providing nerves and urine retention mechanism are better preserved thanks to the magnification, close-up vision and better illumination of the robot.
• Patients with bladder cancer who undergo surgery with Da Vinci Robotic Surgery; begin to eat on the 2nd and 3rd days post operation. If the bowel movements have become sufficient and if everything goes well, they are discharged in less than a week. At the end of 3 weeks with a catheter, the complete healing of the sutures of the urinary bladder formed from intestines is checked, if healing is complete, the catheter is removed.
• In women, in case of bladder cancer the uterus and ovaries are removed as well. Since the uterus is removed from the birth canal, the repair can also be done by the robot during the operation.
Da VINCI ROBOTIC SURGERY IN GYNECOLOGICAL SURGERIES
In addition to urology and general surgery, da Vinci Robotic Surgery is the most common surgical treatment of gynecological diseases. According to 2013 data, the number of surgeries performed with robots in female diseases is higher than urology surgeries. Robot technology has brought a new dimension to long-term laparoscopic gynecology surgeries, thanks to the surgeon’s ability to perform a surgery on the console while sitting down.
Outstanding technology success in cancer surgery
Gynecological, uro-gynecologic and oncologic surgeries are among the most difficult surgeries. Robotic surgery is used as the most advanced technology in all gynecologic cancers except advanced stage ovarian cancers. It can be used in all stages of the “endometrium” cancer, also known as uterine cancer and cervix cancers within surgical margins. Robotic surgery is also used for myomectomy surgeries performed due to infertility and uterine sagging. When the uterine myoma are removed and closed via the laparoscopic method, the risk rupture of the healing area during the next pregnancy may increase due to the failure of the suture. However, the risk of stitching is minimal in robotic surgery thanks to its superior sutures. In the later stages of endometriosis, it is difficult to clean them with laparoscopic surgery because the surrounding tissues are very adherent. Robotic surgery is preferred because movements are performed more easily via robots in such surgeries.
Robotic surgery offers many advantages for both the patient and the surgeon thanks to the technological developments and ease of use. The patient stay and recovery time is much shorter than open surgery. Moreover, there are no surgical traces since only some small incisions are made. Robotic surgery provides easy access to the pelvic system. The mobility of the devices used is also very high. The surgical procedure is carried out in an advanced, comfortable and fast way. The surgery is performed more safely because hand vibrations are not conveyed to the robotic arms. Less risk of bleeding is present. The recovery time of the patient is shortened. The risk of infection is lower. The three-dimensional imaging advantage facilitates the surgeon’s work. Since the surgeon works by sitting on a console during the surgery, it is less effortful and does not affect the surgeons concentration.
The Robotic System, starts with the form of laparoscopy surgery, and used at the stage where superior dexterity comes into use. In this method, no incision the size of a hand is required, neither is hand supported surgery required.
The privileges provided to the patient;
• Better clinical data on cancer control in many cases,
• Faster improvement in intestinal function,
• Faster transition to normal nutrition
• Significantly less pain,
• Lower blood loss, lower risk of wound infection,
• Shorter hospital stay,
• Provides shorter recovery time.
Robotic System In colorectal surgery;used in colon cancer, rectum cancer and prolapse surgeries.
How is robotic surgery utilized in throat cancer surgery
One of the areas where robotic surgery is used is laryngeal cancer. Robotic surgery is advantageously used in early stage patients where the upper part of the throat and the vocal cords are involved. Throat cancer surgery is performed via robotic surgery without opening a hole in the throat, no wound occurs on the neck.
The patient recovers in a shorter period of time and starts to talk and regains the ability to swallow much earlier. Robotic surgery can be used safely in early stage tumors of the larynx.
HPB (LIVER-PANCREAS-BILE TRACT) SURGERY
Instead of the open surgical method for repair, especially in biliary tract injuries, the da Vinci Robotic System is able to perform repair more precisely and without major incisions.
• Neuroendocrine Surgery
• Pancreas body, tail cyst and tumors
• Spleen Protective Surgery
• Gallbladder and Bile Tract Surgeries
• Spleen Surgeries
Robotic Bariatric Surgery-Obesity Surgery:
The global use of the da Vinci Robotic Surgery technology laparoscopically and use thereof in obesity surgeries as well is providing special benefits to the physician the patient. Since the anatomical structures of obesity patients, the extra precision required in such operations can be achieved with the ability to move the arms of the robot with a great dexterity in the abdomen of the patient. Robotic technology, which provides the surgeon with a three-dimensional and high-resolution image, allows the protection of organs, tissues and nerves adjacent to the region where the procedure is performed. In some patients, procedures that can be performed with few or a single hole without creating a surgical incision eliminate the aesthetic concerns of patients.
Tubular gastric surgery and gastric bypass operations are performed successfully by using robot technology in obesity surgeries.
The privileges of the robot technology for the patient and the physician can be listed as follows:
• Since the surgery is performed with a closed technique and through only a few holes, the risk of infection as is present in open surgery is eliminated.
• The surgeon performs the surgery with a 3-dimensional and digital appearance thanks to the robot technology with an opportunity to protect the nerve, blood vessels, muscles and tissues of the patient and decreased likelihood of injury.
• Thanks to robot technology, no surgical incision are required on the patient’s body. Since the procedure is performed through several holes rather than a single large incision, the patient faces much less risk of infection and has a comfortable recovery time with less pain.
• Since the patient’s time of stay till discharge, return to daily life and recovery time is shortened, pain control is provided, the patient is fed orally earlier on and recovers the body resistance in a shorter time.
• Once the patient reaches the quality of daily life, he/she is able to return to work and social life faster.
ROBOTIC SURGERY FOR EAR NOSE THROAT DISEASES
The use of robotic surgery in ear, nose, throat and head-neck surgery provides great advantages for patients. It is used in many ear, nose and throat diseases such as benign tumors and cysts which are located in the larynx, pharynx, tonsils, tongue and mouth. The da Vinci robotic surgery provides a comfortable and safe post operation period for the patients and enables them to return to their normal social life in a short duration.
How is robotic surgery used in ear nose throat surgery?
Robotic surgery is a technique and technology with a past of 10 years. Surgical treatment of ear nose throat problems has been used around the globe and in our country since 2010.
The da Vinci surgical system in general surgery and urology departments is used for surgeries such as abdominal surgeries via robot arms that enter the abdomen through holes on the skin of the abdomen. Otorhinolaryngology operations are performed by entering the oral cavity without any hole or incision. Therefore, in defining this surgical method, the term “Trans-oral Robotic Surgery“ which means ”Through the mouth”.
The da Vinci and trans-oral robotic surgeries are performed with instruments connected to robotic arms. These surgeries are carried out under three dimensional and 16 times enlarged endoscopic images using precision control systems with very small instruments that have the skill and sensitivity that the human hand cannot achieve.
Dependent on the disease on which surgical intervention will be performed, in surgeries performed through the mouth thinner and smaller instruments are utilized than in other robotic surgeries When the human hand is compared to the da Vinci robot; the fact that it eliminates the risk of shaking and has much more movement angles creates the opportunity to perform minimally invasive surgical procedures by protecting the healthy tissues and functions without damaging the vessel – nerve structures.
In which ear nose throat diseases is the da Vinci robotic surgery utilized?
• Benign and malignant tumors of the tonsils.
• Benign and malignant tumors of the tongue root
• Post-nasal, soft palate, cheek, pharynx area related benign tumors
• Benign and malignant tumors of the throat, cysts and cancers.
• The surgical treatment of sleep apnea syndrome and snoring.
In cases of advanced sleep apnea, the use of robotic surgery can eliminate the use of a CRAP device for the patient.
In addition, in the presence of an excessively large tongue (macroglossia), the procedure for manipulating the tongue with robotic surgery can be performed in experienced hands.
What are the advantages of robotic surgery to classical open surgery in ear nose throat surgeries?
In classical surgeries of the ear, throat and head-neck, large incisions are made in the neck area, the face and the jaw bone and the procedures are performed. Since these operations are performed by the oral method of Vinci robotic surgery, the surgery is completed without any incision on the skin and the healing process of the patient is much faster. All these procedures lead to less bleeding, less surgical scarring, and less risk of infection in patients. Patients have a short hospital stay and return to their normal nutritional habits and speech abilities much faster.
• Lack of surgery incision,
• Less pain,
• Less bleeding and reduced need for blood transfusions
• Lack of wound infection due to lack of surgery related skin wound,
• Ability to return to daily life in a very short time
• No need to drill holes in the throat for a procedure called tracheotomy,
• Fast recovery,
What are the advantages of robotic surgery to endoscopic surgery?
• The robot has more mobility than the 5 mm wrist, and the wrist mimicking tips reach the most remote locations and allow the surgical procedure to be performed.
• The ends of the robot can move 540 degrees on 7 planes. Endoscopic instruments can move in one plane.
• The robot eliminates hand shaking. In robotic surgery, the surgeon’s hand does not shake. In endoscopic surgery, shaking is a very serious problem.
• Tools may become curled and bent. Endoscopic instruments are rigid, cannot be bent.
• Sutures can be performed in robotic surgery. While in endoscopic surgery this is not the case.
• Robotic surgery provides a 3-dimensional view. Endoscopic surgery provides a 2-dimensional view
• In robotic surgery, the surgical area is magnified 16 times. Magnification is not possible with endoscopes.
• In endoscopic surgery, the surgeon can only utilize one hand since one hand is occupied holding the endoscope. In robotic surgery, the surgeon can use both hands in the surgical area. In addition, both hands of the surgeon can help with procedures at the surgical site. This enables the possibility of sutures and 4 procedures on the same site. While the surgery durations are shortened, procedures that cannot be performed in endoscopic surgery can be performed via robotic surgery.
How is the da Vinci robotic surgery utilized in sleep apnea surgeries?
One of the newest uses of robotic surgery is obstructive sleep apnea syndrome. In obstructive sleep apnea, some levels of the upper respiratory tract become obstructed during sleep. With known methods, surgery is performed on the soft palate, tonsils and small tongue. However, these methods are not sufficient in more than half of the patients. In most of the obstructive sleep apnea patients, obstruction is observed at the tongue base and at the level of the flap above the epiglottis.
With previously known methods, the root of the tongue and flap above the larynx could not be approached without an incision. However, robotic surgery can be performed easily without a neck incision in this region. A multi-level surgery is performed in patients with obstructive sleep apnea via robotic surgery and all obstructions can be cleared. Patients who have to use sleep breathing apparatus such as CPAP are provided with the comfort of deviceless sleep.