Even robots can learn: For the first time, a surgical robot assisted in a surgical procedure on the abdomen at Vivantes Humboldt Hospital. At the end of July, a team of 10 removed a malignant esophageal tumor from a patient with the help of the DaVinci surgical system – the first operation of its kind in the Berlin-Brandenburg region.
So far, the robotic system at Vivantes Humboldt Hospital has helped treat prostate and kidney cancer as well as reconstructions of the urinary tract. "Esophagectomies usually require opening the abdominal cavity and the thoracic cavity, two body cavities – so a minimally invasive, robot-assisted procedure lends itself to certain patients to reduce stress on the body and postoperative risks," explains surgeon Dr. Colin M. Krüger (MBA), department head of minimally invasive surgery/robotics at the Reinickendorf hospital's Department of Surgery.
Minimally invasive surgery is easier for patients to tolerate, so a shorter stay in the intensive care unit and generally a faster recovery can be expected afterwards, says Krüger: "The decisive factor for the patient is not primarily the type and extent of the operation, but the extent of surgical access to the affected areas of the body."
Patients are turned during surgery
The robot-assisted surgery is performed in two steps – first, the patient lies on his back and the accesses to the abdominal cavity are created – here, first the stomach was reshaped into the later replacement of the esophagus.
Then the diaphragm is opened there at the passage of the esophagus, and the esophagus is prepared with all the associated lymph node stations. Then the esophagus and the stomach reshaped as a replacement are moved to the right thoracic cavity and the diaphragm is closed again.
The patient is then placed on the abdomen and a total of four small accesses to the right thorax are made. The prone position has the advantage that the patient does not have to be ventilated for hours with only one lung, which can significantly reduce complications after surgery.
The diseased parts of the esophagus can then be removed accurately and then the stomach can be connected to the healthy part of the esophagus as an esophageal replacement, so that normal food intake is possible again for the patient. The suture between the esophagus and the esophageal replacement must be able to withstand a great deal – here, the surgical precision made possible by the DaVinciSystem is a major advantage.
Robot supports surgeons, but does not replace them
Since February 2014, Vivantes Humboldt Hospital has been operating with the support of a robot, first in the Urology / Prostate Center and now also in the Abdominal Surgery Clinic. A surgical robot cannot and should not replace the doctor, but it can be a very precise tool. The robot system at Vivantes Humboldt Hospital visually enlarges the operating area by a factor of 10 and offers 3D optics. This allows the doctor to operate even more precisely.
Doctors at Humboldt Hospital are currently collecting data on robotics to advance this new way of operating. "We want to provide study data and thus help prove a clinical patient benefit," says Krüger. This is an important prerequisite for being able to include the new therapy option in the scope of services provided by the statutory health insurance funds, he said.