– The use of the da Vinci robotic system for prostate cancer surgery maximizes the chances of a successful cure, increases the patient’s comfort and accelerates the return to life, sexual and professional fitness – says Dr. a master certificate in robotic surgery of prostate cancer, and recently the only Pole in the board of the European Robotics Society of Urology.
Publication partner: Krakowski Szpital na Klinach
MedTvoiLokony: Are medical robots a new era in medicine and a new quality for patients?
Dr. Paweł Wisz: Surgery has long been looking for surgical methods that would be as least invasive as possible for patients, and at the same time as precise as possible. This is how laparoscopy was born, which allows a camera and surgical instruments to be inserted through small openings into the abdominal cavity. The da Vinci surgical robot, after laparoscopy, is another milestone in minimally invasive surgery. It allows you to perform extremely precise treatments in hard-to-reach places. It is worth emphasizing, however, that the robot does not work autonomously, it is only a perfect tool in the hands of the surgeon, reflecting his movements.
What’s more, the robot has four arms, which means that the operation looks different than traditional or laparoscopic, when the doctor has only two hands and tools at his disposal. For this we have a 10x magnification and a three-dimensional image, and the tips of the robot’s arms can move in the range of 540 degrees.
Therefore, from the perspective of urology, my specialization, the da Vinci robot has revolutionized the way surgery is performed. He permanently visited the operating rooms of the best urology centers in the world.
What makes robotic surgery so precise, especially in the context of prostate cancer?
First of all, the surgeon sees the operating field at ten times magnification. The image shown in the surgical console is three-dimensional, in full HD quality. In addition, the mobility of the human hand is limited and it can only move at certain angles, while the movement of telemanipulator-controlled tools with 7 degrees of freedom is more perfect and breaks human limitations. In the case of highly innervated and vascular structures that surround the prostate, this is extremely important.
Thanks to the enlarged image in 3D technology, our movements are more precise, we are able to accurately dissect the appropriate tissue structures in order to save them. This directly translates into benefits for the patient. The most important thing – we get an ontologically certain result. Curing cancer is our overriding goal. At the same time, we can ensure the patient’s return to the quality of life before surgery. For patients, urinary continence and sexual function are particularly important among the criteria that improve the quality of life.
The method of performing such a robotic operation is also important. The best surgical practice for patients suffering from prostate cancer, which I gained while training at ORSI Academy, is the so-called collar method, developed by Professor Mottrie. I use it at the Hospital in Klinach in Krakow (https://zabiegidavinci.pl/rak-prostaty/) because it brings only benefits for the patient.
Such an operation is minimally invasive and performed in a perfect way, which translates directly into a significantly shorter duration of hospitalization and maintenance of the Foley catheter, which is removed already on the second postoperative day. As a result, the return to full fitness is faster – most importantly – with an excellent result, both oncological and functional, better compared to the results of operations performed with other techniques.
What are the benefits, apart from the precision of the procedure and the absence of scars, for a patient operated with a robot?
Maintaining every millimeter of the urethra intraoperatively is crucial for the quality of life after surgery, including urinary continence. And the robot in the surgeon’s hand, thanks to its delicacy, precision and the ability to visualize the smallest structures around the prostate, gives a better chance of success. In addition, during robotic surgery, there is much less bleeding and the patient recovers faster. At the Hospital in Klinach in Krakow (https://szpitalnaklinach.pl/), we remove the catheter on the second day after surgery and the patient can return home the next day. After classic surgery, the catheter is kept for about two to three weeks, and the recovery period is much longer, slower and less comfortable. After robotic surgery, patients regain continence control in days or weeks, not months. Especially since the disease affects younger and younger men over 40.
It is worth mentioning that although often invisible to the naked eye, all people have micro-trembling hands – and this also applies to surgeons. Although very rarely, trembling hands can lead to surgical errors, nevertheless there is always such a risk. Here again, the solution to this problem is the da Vinci robot, which allows me to use my zero-shake robotic hands.
In addition, it enables very precise work – more precise than I could do with my own hands. For example, if I manage to remove the cancerous prostate during surgery while maintaining a margin of healthy tissue, additional treatments such as hormone therapy or radiation therapy are not necessary. So it’s not science fiction anymore, we surgeons really have such devices at our disposal.
The use of robots in surgery is a very modern method, but is it really proven?
The da Vinci robot has been used in surgery since 2000, i.e. for 20 years. Currently around 5,3 thousand people work around the world. such robots. In the USA, already 98 percent. urological procedures are performed exclusively by robotic surgery. Europe is also strongly developing this area of surgery. We have the European Society of Urology with a robotic section initiated by the world leader in robotic surgery in urology, prof. Alexandre Mottrie. In 2010, he founded Orsi Academy – the largest robotic surgery training center in the world, outside the US. In 2015, the first training program in the world that underwent a validation process was created.
It is a very systematic program educating doctors in robotic surgery, aimed at obtaining repeatable and good results. I am a graduate myself, as well as one of 12 urologists in Europe who completed the course under the supervision of prof. Patel, a US urologist who has performed the most robotic prostate cancer surgery in the world. And now I will be responsible, as a board member of the European Robotics Society of Urology, for the standardization of training processes for robotic surgeons in Europe.
Are many doctors able to perform such operations?
This is one of the problems of robotic surgery – the problem of the shortage of robotic operators. Experience in open and laparoscopic surgery does not translate into robotic surgery. The use of robots requires a completely different model of education. Doctors should learn skills outside the operating room, much like pilots, using simulators. The best European training center is in Belgium. A doctor who has already gained the fitness in the simulator performs the first treatments on people under the supervision of an experienced specialist.
During such an operation, two consoles are used and in case of problems, an experienced doctor can take control of the robot. Unfortunately, such training is still elite, and the next available dates are in 2026, because Professor Mottrie only accepts two people a year to be able to devote his time fully to them and bring their skills to perfection.
How many da Vinci robots are there in Poland? Does the National Health Fund refund such operations?
We currently have eight da Vinci robots in Poland. Unfortunately, this is still not enough for the population of Poland and compared to the Czech Republic, where they have ten robotic systems, and in Germany – as many as 140.
Unfortunately, operations with the use of a robotic system do not have dedicated financing from the National Health Fund, although in many countries they are already standard. Scandinavian countries even require a robot to operate in urology, because they have calculated that in the long run it pays off for the national economy. In Poland, patients still have to pay themselves, and this costs about 45 thousand. zloty.
Do you think that new technologies in medicine always open up new possibilities? What is worth remembering when practicing this profession?
Technology is always only as good as the person using it. It’s just a tool that can’t be good or bad, but the person who uses it can. The technology can be more or less complex, but especially in surgery, it must be used by people with specialized training and extensive clinical experience. The surgical robots we use are very complex machines and without the appropriate training of the surgeon and the many hours spent by him in the operating room, these advanced machines do not provide the expected benefits.
As a da Vinci robot surgeon, I need to be familiar with both the technology I work with and the tools I receive that become my hands for a few hours. That is why it is so important in the case of new medical technologies to adapt training for future surgeons in such a way that, on the one hand, they can take full advantage of the new solutions, and on the other hand, they can manage and use this solution so that it is safe and, above all, safe. , benefited the patients the most.
Publication partner: Krakowski Szpital na Klinach