Overcoming Boundaries through Robot Surgery 2018.01.26

CHA Bundang Medical Center Robot Surgery Center: Overcoming Boundaries through Robot Surgery

Robot surgery began in 1983 in the county of Canada. It began with the creation of the “arth robot”, which was developed by an orthopedic surgeon and his team members, and has since seen substantial growth. It is now being widely used in otolaryngology, surgery, urology, gynecology, and many other fields. According to Intuitive Surgical, Inc., robot surgery doubled between 2007 and 2013, and 1.5 million robot surgeries were conducted up until 2013 worldwide.

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

① Myomectomy
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.

② Hysterectomies
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.

③ Sacrocolpopexy
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

① Solenoma
Most published research reports that robot surgery is inferior or simply not superior to laparoscopic surgery. In a significant amount of research, robot surgery has shown lower blood loss and shorter post-surgery hospitalization periods compared to laparotomic surgery. With regard to the surgery time, laparotomic surgery was seen to be shorter.

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

Pancreatic cancer is one of the most complicatedly entangled conditions in the human body. As such, when cancer forms it is difficult to discover in the early stages, and metastasis is also frequent, causing it to be extremely dangerous. When doing surgery, a high-degree of focus and detailed technique is required, and laparoscopic surgery is also the slowest progressing field compared to other illnesses. However, robot surgery can move similarly to laparotomic surgery and is able to magnify the surgical area to a maximum of 10 times through 3D stereoscopic imaging.

Due to accessing the surgical site by using thin devices of less than 1cm in diameter, complicated blood vessels or nerves are able to be preserved during surgery. Furthermore, this technology compensates for unstable human hands, increasing the safety of the surgery.

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

Robot surgery is especially fit for women planning on becoming pregnant or giving birth. The advantage with respect to uterine cancer is that there is a lower occurrence rate of surgery complications compared to other surgery methods. Professor Hyun Park of the gynecologic cancer department and professor Sung Hoon Choi of the department of general surgery experienced success in 2015 when they attempted to excise both hysteromyoma and the gall bladder in the opposite location at the same time using single-port surgery on a 49-year-old female patient diagnosed with cholecystitis that accompanied hysteromyoma and gallstones.
Single-port robot surgery has a high satisfaction rate among females sensitive to scars due to it reducing the burden of repeated surgeries or post-surgery scars.

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
CHA Bundang Medical Center’s robot surgery center is showing an average increase of over 20% every year since introducing surgery robots, and it is rapidly growing. I believe sharing opinions about robot surgery and fostering skills through regular workshops and endless research is one aspect of growth. We plan to work to continue to hold our place as a center focused on raising the satisfaction of our patients.
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