February 4, 2015

Robotic Surgery – An affordable luxury for our health

Dr. Konstantinos M. Konstantinidis MD, PhD, FACS
Scientific Director of AMC.

Robotic surgery has become a reality since 2000, due to advances in robotic technology and its application in medicine. Originally the prospective involved the feasibility of surgical interventions within large distances (telesurgery). US space and military programs, intensified research in order to provide surgery from earth to astronauts, or to provide surgical intervention to injured soldiers in the line of duty, by qualified specialists from a remote medical center. In 2001, J. Marescaux, was the first surgeon to perform a minimally invasive cholecystectomy to a patient in Strasbourg- France, while he was in New York (Lindberg operation). In these endeavors, robotic surgery seemed to have even more advantages, overcoming the limitations of conventional laparoscopic surgery, principally because the robotic instruments are articulated with far greater maneuverability and three-dimensional vision allowing more accurate perception of the surgical field.

The robotic systems became worldwide popular in medicine, since the company Intuitive Surgical constructed the da Vinci system which received an FDA approval for a wide range of surgical procedures including general surgery, urology, gynecology, ENT, thoracic surgery, heart surgery. In Greece, the first robotic operation was performed by Dr. K. Konstantinidis and his team in Athens Medical Center in September 2006. The first announcement that the robotic surgical program is running in our country, took place in February 2007, in New York, at the 2nd World Conference for Robotics Surgery (MIRA 2007). Today there are over 1957 robotic systems installed in the US, 26 in Latin America, 430 in Europe, 26 in the Middle East, 220 in Asia and 29 in Australia. In Greece there are 7 robotic systems.

Robotic surgery is a minimally invasive method. It ensures minimal blood loss and less post-operative pain. It reduces the likelihood of intra-operative and postoperative complications. It significantly reduces duration of hospitalization and provides better cosmetic results. Additionally, it overcomes limitations of conventional laparoscopy such as the two-dimensional vision, the unsteady image, the limited movements of instruments, as well as ergonomic issues for the surgical team. Furthermore, robotic surgery enables conducting single-incision operations (i.e. Single-Site) with much greater ease and security compared to single-site laparoscopy, in which there are difficulties mainly due to instrument crowding and limited freedom of movement.

Robotic Surgery foto1It allows the surgeon to have three-dimensional (3D) image of the surgical field, at a very high magnification. It also ensures greater accuracy in surgical movements. The surgeon’s console movements are being transferred to smooth robotic instrument movements, because the physiological hand tremor is eliminated, thereby augmenting the surgical skill. The system also gives the surgeon the ability to perform complex surgical maneuvers within narrow operative field. The surgical instruments are able to perform all possible movements of the human hand (7 degrees of freedom in movement) with great precision, and more, since they can rotate almost 360o. Another advantage is that It gives the surgeon greater comfort during the procedure. Unlike conventional surgery, robotic surgery allows the surgeon to operate while seated within a carefully designed optimal position and within an ergonomic environment. It also allows the surgeon to plan the procedure prior to operation by reviewing patient’s own imaging examinations through the system’s console, or even go through them at any time, during the procedure. The surgeon directs and coordinates the whole system through the console, at which through special goggles he experiences an enlarged three-dimensional image of the surgical field. The surgical console has handles, “the masters”, with which every movement of the surgeon’s hands is transferred with absolute precision and stability to the tips of the robotic arms within the surgical field. The surgeon is able to directly communicate with his bedside surgical team through integrated speakers, thereby has a full perception of the operation theatre.

The spectrum of general surgery laparoscopic operations being done robotically nowadays, is rapidly extending providing a series of important advantages to the patients and includes cholecystectomy, restoration of gastroesophageal reflux (GERD) and esophageal achalasia, repair of inguinal hernias and abdominal ventral hernias, treatment of diseases of the colon, stomach, liver, pancreas and spleen, endocrine surgery such as adrenalectomy, morbid obesity surgery such as gastric sleeve and bypass, and many more.

Many people consider robotics an unaffordable luxury and the cost issue is being currently discussed in international surgical conferences. Studies show that the benefits of robotic surgery outweigh the cost difference with a laparoscopic or open surgery. The quick recovery with less hospitalization, less medication and minimization of complications which may potentiate the hospital cost, are greatly decreased with robotic surgery. In Greece, robotic operations are covered by most private insurance companies while the difference with laparoscopy is arguable even for patients with no insurance.

The team of Dr. K. Konstantinidis in Athens Medical Center, gathers today, most extensive experience in Europe and one of the largest in the world in the field of robotic surgery in general surgery with more than 1.200 operations. The same team pioneered worldwide robotic operations through only one incision (i.e. Single Site Robotic Surgery) in 2011 and still receives honors in all major international conventions.