CHA Bundang Medical Center Robot Surgery Center: Overcoming Boundaries through Robot Surgery
The robot surgeries presently being conducted are laparoscopic surgeries that involve the surgeon sitting at the console and remotely controlling the robot arm, as pictured above. The robot systems used universally at present are the da Vinci Si and da Vinci Xi systems. The Xi system is a new-version robot system that was created to compensate for the flaws in the Si system.
1. Robot Surgery in the Field of Gynecology
Presently, robot surgeries are being conducted widely in the field of gynecology to treat benign diseases such as myoma, ovarian tumors, endometriosis, and uterovaginal prolapses, as well as malignant diseases such as endometrial cancer and ovarian cancer. They are also being used to perform surgeries such as fallopian tube or ovary adnexectomies, myomectomies, and lymph node biopsies.
Ⅰ. Robot Surgeries for Benign Gynecological Diseases
A significant amount of research has been published comparing the surgery time, complications when doing surgery, status post-surgery, and other factors regarding present laparoscopic myomectomies, laparotomic myomectomies, and robot myomectomies. Robot myomectomies have shown to be superior in the aspect of morbidity rate when compared to the present laparoscopic and laparotomic myomectomies, and they also show to be superior to laparoscopic myomectomies on qualitative sutural aspects as well. There were no significant differences with regard to post-surgery fertility when compared to present laparoscopic and laparotomic myomectomies.
In published randomized controlled trials, robot surgery was conducted as a benign disease indication. When conducted under the control of a skilled operating surgeon, there did not show to be significant differences in morbidity, surgery time, blood loss, post-surgery hospitalization period, and other factors when compared to present laparoscopic hysterectomies. Furthermore, the surgery time was longer when compared to laparotomic hysterectomies, however it showed to be advantageous with regard to blood loss and post-surgery hospitalization time.
When comparing robot sacrocolpopexy and uterosacral syndesmopexy after colpohysterectomy, robot surgeries lessen pain and use less anesthetics. However, surgery time has shown to be longer, and there have been no notable differences after 2~6 weeks post-surgery. Single-port robot colpopexy shows advantages such as a low complication rate, low pain, quick recovery, a short post-surgery hospitalization period, and low operation wounds.
II. Robot Surgery for Malignant Gynecological Diseases
② Cervical Cancer
In a multitude of research, robot surgery has
shown to have a shorter post-surgery hospitalization period when compared to laparotomic surgery.
When compared to laparoscopic surgery, the surgery time was shown to be similar, as were post-surgery hospitalization period and total lymph node count.
③ Ovarian Cancer
In one piece of research, there was reported to be no significant statistical difference among two groups when comparing robot surgery and laparoscopic surgery, regardless of FIGO stage, histology, or tumor grade. Surgery time was shorter in robot surgery, and the amount of blood loss was similar. There did not appear to be any significant differences with respect to surgery complications, either.
2. Robot Surgery in General Surgery
Pancreatic Cancer Difficult to Approach?Important to Remove Safely and Accurately
After the world’s first successful robot surgery for choledochal cysts in 2014, CHA Bundang Medical Center professor of general surgery Sung Hoon Choi has been reporting various different positive results, including another robot surgery success in which, for the first time worldwide, ampulla of vater tumor
was successfully treated through robot surgery in 2017. While doing so, Mr. Choi is also striving to increase patient treatment satisfaction rate.
‘Single-Port Surgery’, Done Through Tiny Holes in the Navel Area, Shows Almost Zero Contusions
3. The Advantages of Robot Surgery
Several pieces of published research show results in which both morality and morbidity improve in patients that have received robot surgery. Results have shown advantages in which patients who have received robot surgery see a reduction in the length of their hospitalization periods, a decrease in post-surgery pain, fewer abrasions or contusions remaining, a decrease in bleeding during surgery, a lower danger of infection, and faster recovery that lets patients return to normal life earlier.
① Compared to the present conventional laparoscopy, a three-dimensional view helps in surgery.
② Hand tremor of the surgeon is close to zero, meaning the accuracy of the surgery is high, and thus fitting for microsurgery.
③ The free angle of the robot’s arms offers greater advantages than present laparoscopic surgery with regard to microsutures and when excoriating tissue in locations that are difficult to access.
④ The surgeon is able to control the camera and surgery devices, meaning he or she can perform surgery without being largely influenced by the skill level of the assistant.
4. Single-Port Robot Surgery
The da Vinci Si and da Vinci Xi systems are fit for all single-port surgeries. As shown in the drawing below, the robot arm is installed through one incision site at the navel region. The device uses a collapsible wrist and works to minimize device bumps, reducing movement constraints.
The da Vinci Xi system performs convenient docking, in which the robot arm is installed at the patient’s naval region. The robot arms have been tapered off further, and the movement angles have grown larger without unwanted external contact to the device, making it easier to access the site of surgery. Due to this advantage, it appears to better fit single-port surgeries.
5. An Interview with the Head of the Robot Surgery Center: Jong Woo Kim