Following a global trend, robots that can assist doctors in the OR are on the rise in Czech hospitals
In 2001 a surgeon sitting in a high-rise building in New York City removed the gallbladder of a woman lying on an operating table in Strasbourg, France. The distance separating the two was 7,000 kilometers (4,300 miles).
The doctor, Jacques Marescaux, used a surgical robot that enabled him to use joysticks on a console to move stainless steel arms holding instruments on the other side of the Atlantic. A fiber-optic cable connected the doctor and the mechanical surgeon.
Since then, robot-assisted surgery has proven itself throughout the world — and not just in extending the reach of surgeons, but in doing what they can’t.
Two hospitals in the Czech Republic now have robots similar to the one used by Marescaux: Na Homolce Hospital in Prague 5 began operating with one in late October, and the Central Military Hospital in Prague 6 performed its first three robot-assisted surgeries last month. Some 25 Czechs have undergone robot-assisted surgery so far.
At least one additional facility — most likely one of the teaching hospitals in Brno — plans to buy the same type of robot this year. As many as 10 could be in operation by the end of the year throughout the country.
Called da Vinci, the American-manufactured machine has a camera, a monitor and four arms that can hold instruments. The operating console features pedals, joysticks and a three-dimensional view screen.
“This technology moves surgery several steps forward,” says Martin Kaloš, director of the robotic division at Hospimed, the firm that distributed the da Vinci models in the Czech Republic.
Fewer cuts, less infection
One of the biggest advantages of robot-assisted surgery is that it’s less invasive than open surgery, doctors say. Several half-inch incisions are generally all that’s needed for robotic surgery. And if doctors don’t need to cut the patient open, it minimizes the risk of infection.
More importantly, robots enable surgeons to reach places the human hand can’t normally get to without difficulty. That’s why the da Vinci is most commonly used for prostate operations, gastric-bypass procedures and gynecological surgeries.
Laparoscopy, or examination and surgery aided by a miniature camera and light that’s inserted into the body of a patient, debuted in the late 1980s and works on a similar principle. With robotic surgery, however, it’s the arms of the robot that hold the instruments, allowing for greater control and steadier movement.
Another advantage is the three-dimensional monitor that allows the surgeon see more accurately how the operation is going.
“I almost feel as though I was inside the patient’s stomach,” says Oto Köhler, head of the urology department at Central Military Hospital.
Patients not afraid
Some patients, of course, may need more convincing and could be forgiven for being nervous about going under a knife held by a robot. But doctors emphasize that the robots merely assist in surgeries, as if they were extensions of their own arms.
“The key thing to remember is that it’s the surgeon doing the operation, not the robot,” says Köhler.
The surgeon sits at the console, operating controls that resemble those of a video game. The robotic arms holding the camera and instruments can’t move without the surgeon moving the joysticks at the console. “It can’t be programmed like an airplane flying on autopilot,” says Michal Tob?rný, deputy head surgeon of at the Na Homolce Hospital.
It takes surgeons about three weeks to train for robotic operations.
Tob?rný says he was almost surprised by how receptive patients are to the new technology. Doctors inform every patient who is a candidate for robotic surgery about the technology and give him or her the option to decline the procedure in favor of traditional surgery. So far, no patient has refused.
An expensive aide
Still, it may be a while before every hospital has a da Vinci. “The biggest obstacle to having the robot in more hospitals is the price,” says Kaloš.
At 45 million K? ($1.8 million), surgical robots demand a serious commitment of resources. Just one surgical instrument, such as a specially modified scalpel that can be attached to the robotic arms, can cost around 100,000 K? — and for safety reasons each instrument has a limited number of uses, some as few as 10.
Because the procedure is so expensive — one operation can cost as much as 100,000 K? — surgeons only use this technology when the benefits are worth the high cost.
“It doesn’t make sense to use the robot in routine, simple surgeries,” says Kaloš.
The American Food and Drug Administration approved robot-assisted abdominal surgery using the da Vinci in 2000 and nearly 400 robots now operate worldwide. The United States has about 200; in Europe, Italy leads the way with 23.
Despite the cost, surgeons expect robotic surgery to become more commonplace in the next few years.
Tob?rný admits that if someone told him 10 years ago he would be operating this way, he wouldn’t have believed it. “When laparoscopy first started, people didn’t believe it would catch on very quickly,” he says. “Now every major hospital performs laparoscopy.”
But doctors say that three or four surgical robots for the entire Czech Republic is probably enough. The parts of the world that could benefit most from surgical robots are the ones with low population densities, where hospitals that lack specialists for more complex surgeries could
Source: The Prague Post, Written By: Kristina Alda (Staff Writer)
lilgeek says
holy shit this is awsome!!!!!!!!!!!!!!!!!!!
way better than the bar tending robot or is it…