Rapid technological developments have produced new inventions, such as robots, and introduced them into our daily lives. Today, robots perform vital functions in homes, space, military institutions, and hospitals.

The development of robotic surgery has provided hospitals and healthcare providers with a valuable tool that has a profound impact on high-tech surgical procedures.

Robotic surgery essentially means that the surgeon controls the robotic arms, which are inserted inside the operating area, from a console separate from the robotic arms. The surgeon visualizes the operation site through a high-definition 3D camera and its movements are reproduced by the robot.

There are currently over 3,000 Da Vinci robotic systems installed worldwide.

When is the robot used?

Surgery known to the public as “closed surgery” (laparoscopy) can be performed by robotic surgery. These include a wide variety of operations, from gallbladder surgery to gynecological surgery. This modern surgical procedure is called “minimally invasive surgery.” The aim is to keep the organs as intact as possible and to minimize damage to the surrounding tissues when performing the necessary surgeries. This is for the benefit of patients and is important for surgical success, with fewer side effects.

Why robotic surgery?

  • Smaller incision, smaller scars and better cosmetic appearance
  • Eliminates surgeon’s hand tremor
  • Less blood lost during surgery, so less need for blood transfusions
  • Less pain and less post-operative analgesics
  • Shorter recovery period, shorter hospital stay
  • Faster return to daily activities
  • Low risk of infections
  • Fewer complications

Robotic system DA VINCI

Today, the Da Vinci robot is the most advanced example of a robotic surgical system. The Da Vinci system consists of a portable robotic tower and a surgeon’s console.

The center arm of the robotic tower holds a video camera that includes two separate lenses for binocular vision. The camera provides an authentic three-dimensional (3D) view with an enlarged (6 x 3 x 10) image of the surgical field.

Three instrument arms starting from the tower holds and handles the surgical instruments.

The surgical instruments are articulated at the wrist with seven degrees of freedom. The bidirectional joint and grip method mimic the authentic movements of the surgeon’s hand and wrist. The hand-eye axis of the surgeon is positioned so as to create the illusion that it is operating on the patient. Every move that the surgeon makes is copied exactly by the robot, which makes the operation perfect.

Places that cannot be accessed by hand and the surgeon’s instruments in an open operation can thus be penetrated with minimal damage to the surrounding tissues. The main reasons for applying robotic surgery include the ability of the robot’s arms to move freely inside and perform the functions of several surgical instruments at the same time, causing less bleeding and a shorter recovery time.

Areas where Da Vinci robotic surgery is commonly used:

  • Robotic urological surgery
  • Robotic obesity surgery
  • General surgery
  • Cardiac surgery
  • Gynecological surgery
  • Thoracic surgery

Urological surgery with the Da Vinci robot

The field of urology is an area of ​​medicine that has adopted and incorporated robotic surgery into its surgical equipment. Every day, innovative robotic surgical applications and techniques in the field of urology are developed and communicated. Increased use and development have fueled the discovery of new applications of robotic systems in urological surgery.

Urology is going through a huge technological revolution with the introduction and application of robotics in urological surgery. The use of robotic movements has brought a huge leap forward in laparoscopic surgery compared to traditional laparoscopic techniques by its precision of cutting and, more importantly, by reconstruction and suturing.

In urological surgery, the Da Vinci robot is used for:

  • Robot-assisted radical prostatectomy surgery (RARP)
  • Kidney cancer
  • Radical nephrectomy (complete removal of the kidney)
  • Partial nephrectomy
  • Kidney stones

Robotic Assisted Prostatectomy (RARP)

Currently, the most common robotic urological operation performed is the robot-assisted radical prostatectomy operation. Currently, in the United States, the vast majority of radical prostatectomy operations are performed using the robot.

Traditionally, radical prostatectomy operations are performed through a large surgical incision that causes: slow recovery after surgery, longer hospital stay, higher risk of wound infection, and a large scar after incision. Robotic prostatectomy helps doctors perform the operation through very small incisions that give patients a minimally invasive and less traumatic treatment option.

The 7 ° wrist instruments are the distinct advantage of robotic systems in the case of RARP. These instruments make movements easier in a limited surgical field, such as the pelvis, and allow for precise dissection. The functions of scale measurement of movements and filtering of hand tremor increase the potential of precise surgical techniques.

RARP reports have shown that when robotic surgery is used, there is a significant reduction in estimated blood loss, transfusion rate, hospitalization period, catheterization period, and perioperative complications.

Surgery to treat obesity

Robotic surgery offers various benefits for severely obese patients and patients who have had surgery before. Through newly developed single-incision robotic surgery, it will be possible for obese patients to be operated on without leaving any scars. Florence Nightingale Metabolic and Obesity Center is ready to help.

In the case of surgery to treat obesity, the Da Vinci robot is used for

  • Gastric bypass
  • Longitudinal gastrectomy (gastric tubing)

The use of minimally invasive techniques in surgery is the most important development for modern surgery and offers many advantages over classic open surgery techniques.

Robotic surgery has many advantages over open surgery, including a shorter hospital stay, reduced morbidity and a shorter recovery period. Robotic surgery has become widely used as a standard procedure for many abdominal and pelvic surgeries. Robotic surgical systems were introduced into intra-abdominal surgery in 2000 when the Da Vinci surgical system was approved by the FDA (US Food and Drug Administration). Robotic surgical procedures have become widely used worldwide and are considered to represent the era of laparoscopy surgery.

This technology offers technical advantages over laparoscopic surgery when working deep areas that are difficult to reach, such as abdominal surgery, hiatal hernia, esophagus and rectum. For complex cases, robotic surgery is expected to replace conventional laparoscopic surgery, and single-incision laparoscopy will become the standard procedure for simpler cases.

In general surgery, the Da Vinci robot is used for:

  • Colon cancer, rectal cancer, diverticulitis and its complications, and inflammatory bowel disease
  • Anti-reflux surgery and hiatal hernia
  • Esophageal cancer, achalasia
  • Stomach surgery and small intestine
  • Stomach cancer (subtotal and total gastrectomy)
  • Pancreatic tumors
  • Benign and malignant cysts of the pancreas
  • Elimination of the gallbladder (cholecystectomy)
  • Liver resections and biliary tract operations
  • Operations of the adrenal gland
  • Thyroid surgery

Cardiac surgery

Conventional cardiac surgery is performed through a standard chest incision (median sternotomy) and using devices for the heart and lungs. Minimally invasive techniques have tried to make cardiac surgery less invasive by removing the large incision and / or devices for the heart and lungs.

Robotic surgery offers great benefits. A three-dimensional image is an advantage for a surgeon who is unfamiliar with working with two-dimensional images. In addition, performing precise manipulations with long devices through a limited opening causes hand tremors and fatigue. Robotic surgery eliminates this disadvantage.

Every year, an average of 1,700 robotic cardiac surgeries are performed in the United States. Every year this figure increases by 400, an increase of 25%. Turkey’s first robotic system was installed at Florence Nightingale Hospital in Istanbul in 2004, and more than 300 heart patients have been successfully operated on to date.

In cardiac surgery, the Da Vinci robot is used for:

  • Mitral valve repair and replacement
  • Coronary artery bypass graft (patients with a single coronary artery or a coronary artery bypass graft)
  • Atrial septal defect closure
  • Arrhythmia operations
  • Heart tumors

Gynecological surgery

In Turkey, only a limited number of centers perform robotic gynecological operations.

The Da Vinci robot in gynecological surgery is used for:

  • Removal of the uterus (hysterectomy)
  • Ovarian cyst surgery
  • Uterine fibroid / myoma surgery (myomectomy)
  • Gynecological cancer operations

Thoracic surgery

The use of Da Vinci robotic systems in thoracic surgery was approved by the FDA in March 2011. Since then, Group Florence Nightingale has performed the largest number of robotic thoracic surgeries in Turkey.

In thoracic surgery, the Da Vinci robot is used to:

  • Mass / tumor / breast cancer surgery
  • Chest cancer surgery (VATS segmentectomy, lobectomy) and lymph node resection
  • Surgery to diagnose lung nodules
  • Pleural biopsy and pleural surgery by VATS
  • VATS peeling operation
  • Thymus operations