7 March 2019 Author : Kris Maes This approach is a combination of laparoscopic, thoracoscopic and other traditional minimally invasive surgical techniques with the use of a robotic device. How does robotic surgery work? The robotic surgery systems at the Hospital da Luz (Da Vinci SiHD and Da Vinci Xi) consist of 3 components: Surgical console; Body with robotic arms; Command tower with special processors and 3-dimensional (3D) high-definition (HD) image system. The surgeon sits in the console and performs the procedure by operating the controls directing the robotic arms . The procedure is guided by a three-dimensional image of the area of intervention, in high definition and present in the operator’s natural field of vision. The articulated and interactive robotic arms respond in real time to the surgeon’s commands. In this way, they can replicate the movements of wrists, hands and fingers with extreme precision but on a scale that is appropriate to the small size of the surgical instruments attached to them. The surgical instruments gain access to the operative field through small incisions on the body wall , known as ports. In conventional minimally invasive surgery the surgeon handles these instruments directly, whereas in the case of robotic surgery it is the robotic arms of the system's body that do this, always under the command of the surgeon in the console. As with all other types of surgical intervention, with the da Vinci robotic surgery system the patient is at all times under the full control of the surgeon and his team. Interaction between the surgeon and his team is made possible by a microphone in the console , a sound amplification system and monitors in the room that transmit the same image of the operative field the surgeon is seeing in the console. During the operation, the surgeon's assistant and theatre nurse always remain next to the patient. They watch the surgeon select and change the instruments and help connect them to the robotic arms or perform other necessary tasks. The Da Vinci surgical system is extremely safe . It has multiple safety systems and cannot be programmed, nor does it make decisions by itself. Each manoeuvre requires a direct contribution from the surgeon, and during an operation the system carries out numerous safety checks. In the event of a power failure or safety check, the system allows the surgeon to maintain full control of the intervention. What are the advantages of robotic surgery for patients? As a general rule, the main advantages of robotic surgery over open surgery are all the known benefits of minimally invasive surgery: Less post-operative pain; Lower burden on and better response of the immune system; Faster overall recovery; Faster return to work; Lower incidence of infections; Lower incidence of incisional hernia; Surgery scars that are hard to see. What are the technical advantages of robotic surgery? Robotic surgery has technical characteristics that increase the safety of procedures and enhance the advantages of minimally invasive conventional surgery for patients, in particular: Higher definition of images with three-dimensional pictures; The digital interface filters out natural tremor and increases the accuracy of the surgeon’s movements; The robotic arms rotate around a fixed point on the wall, reducing the traumatic tension upon it, which should result in even less post-operative pain; The relative positioning of the surgeon, the field of work and the surgical instruments (ergonomics - important for the surgeon's performance) is potentially perfect; The freedom of movement of the instruments is great and replicates the potential movements of the human fist; Tissue dissection and identification of the natural anatomical planes are easier and better defined; Manual stitches are more accurate and safer. In which areas is robotic surgery used? Robotic surgery has several fields of application , including: Urological surgery, particularly in the treatment of prostate cancer; Gastrointestinal surgery, particularly in the treatment of rectal cancer and in obesity surgery (or bariatric surgery); Heart surgery; Gynaecological surgery; Otorhinolaryngological surgery. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
