We witnessed robotic surgery. “We operate with levers”

We witnessed robotic surgery.  "We operate with levers"

The Robotic Surgery Center operating within the Military Institute of Medicine has two modern da Vinci surgical robots. As part of the “Science is a Polish specialty” series, we visited this place and saw how surgeries are performed using robots.

The Robotic Surgery Center has been operating within the Military Medical Institute – National Research Institute for several years. It has two da Vinci surgical robots, which are used to perform surgeries in nine different specialties.

Robot in the operating room

– An operating robot is a structure whose concept was created several dozen years ago – says the head of the Center, Col. Jacek Doniec, MD – It was a concept created for the needs of the United States Army, to have a robot on the battlefield that would operate on a soldier on the spot. From this concept, when prototypes and tests began to be created in the laboratory, it turned out that telemanipulators had actually been created, i.e. tools that could be controlled remotely. They were combined into a body and we came up with this robot – he describes.

Robots of this type have proven to be very useful in use outside the military. It turned out that telemanipulators have many advantages that eliminate the problems of laparoscopic surgery.

– The operator sits a few meters, but may sit several dozen, several hundred, or even several thousand meters from the operated site. And the operations are performed by manipulators that are controlled remotely. However, the operator has full control over the procedure and the movements of the manipulators from beginning to end, the doctor points out. – The robot is designed to ensure maximum safety. When the operating surgeon removes his head from the viewfinder, the operation will be interrupted at this point. All we have to do is lower our hands and the robot stops, says the head of the Robotic Surgery Center.

Surgeon about the advantages of surgery using a robot

As we saw in two operating rooms at the Military Medical Institute in Warsaw, the four interconnected arms of each robot are located a few meters from the console behind which the surgeon performing the operation sits. Lt. Col. Tomasz Syryło, M.D., from the Department of General, Functional and Oncological Urology of the Military Institute of Medicine, who performed radical prostatectomy surgery that day, told us about the advantages of using the robot.

– I’m sitting at the console, I don’t have to stand. We operate using levers, these are manipulators that move the robot’s arms – explained the doctor. – The great advantages of the robotic system are primarily the ability to operate in three dimensions. This means the possibility of approximately ten-fold magnification, elimination of tremors in the surgeon’s hands and high precision when preparing important anatomical structures, which translates directly into the results of the operation for the patient – he pointed out.

Dr. Syryło also described what the individual robot arms are for. – We operate using four arms that are in the patient’s abdomen to create a pneumothorax, similarly to laparoscopy. The first arm is the working arm, it is the Prograsp, the holding tool. The second tool is the Maryland, it is a bipolar coagulation tool. The third arm is the camera. The fourth tool is scissors with monopolar coagulation. The assistant has two ports for suction and clipping, the surgeon said. – The arms can be freely changed depending on the side being operated and the operator’s preferences. We have high possibilities of adapting the device to particular conditions, whether anatomical or to the surgeon’s preferences – he added.

The robot operator is accompanied by the entire team

During surgery in the operating room, the robot operator is, of course, not alone.

– There is a doctor who assists. Most often, it is a young doctor who is interested in robotics. In a few years, when the saturation of robots will be greater, these doctors will have to take over from us. Then we will teach, we will show, and they will operate. This is what it looks like in medicine. First you assist, then you operate yourself, this is how you gain experience – explains the head of the Center.

Instrumentalists also take part in the operation. – Their presence is one of the key elements when it comes to the procedure. They are often underestimated, but without them the procedure would not run smoothly. They know how to connect a given tool, how to clean it, whether it works properly or not – emphasizes Dr. Doniec.

The operating rooms themselves are also very impressive. The operating table is integrated with the robot and changing its position changes the robot’s arms. However, around the room there are numerous screens showing live images from the robot’s camera located inside the operated patient. This way, all doctors participating in the operation can see exactly what is happening to the patient at a given moment.

The operation in which we participated as observers was successful. You can see a video of our visit here.

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