DA VINCI ROBOT
PATRYCJA JENCZMIONKA-BŁĘDOWSKA
The capital of Lower Silesia hosted surgeons famous in the world, from a few countries of Europe and the USA. On 4-5 March 2016 in Wrocław there was the Second International Congress of the Polish Association of Robotic Surgery and the First Polish-Italian Symposium of Robotic Surgery in Oncology
It is not accidental that the congress was held just in Wrocław. The capital of the Lower Silesia is connected with the history of the Polish and European surgery. The city is the home of the worldly thoracic surgery. It is the place where Jan Mikulicz-Radecki completed the first operation in the world on an open chest. – After 80 years we did an operation with the usage of the da Vinci robot within the World Innovation Day; today Wrocław is an European capital of culture, therefore it was so important for us to organize such a congress – says prof. Wojciech Witkiewicz, a chairperson of the Polish Association of Robotic Surgery.
Wrocław history
Why did the robot get to Wrocław? In 2009 prof. Witkiewicz as a chairperson of the Association of Polish Surgeons organized here a congress on the 120th anniversary of establishing the Association by Ludwik Rydygier, and it was also the Innovation Year. Opening the event, the professor promised Polish surgeons to do everything so that in the future they could learn on the modern equipment which is the da Vinci robot and take advantage of it. And it happened so. The dream came true a year later. Thanks to the favour of the Ministry of Education, prof. Witkiewicz managed to buy this equipment and import it to Wrocław, as well as organize trainings for people, create a team and start doing operations.
In the District Specialist Hospital in Wrocław, the da Vinci robot has been used in operations for years, which is the first surgical robot in Poland. So far over 200 such operations have been done. However, the National Health Fund does not fund these operations done with the usage of da Vinci, because they were not included in the guaranteed benefits.
Not funded method
The main purpose of the congress was presenting the most modern standards of using the surgical da Vinci robot in general surgery, oncology, urology, gynecology and laryngology. One of the organizers’ purposes is to make the Wrocław congress a platform of discussions on possibilities to finance robotic surgical procedures in Europe and Poland.
- Operations with classical method or with the usage of laparoscopy are much cheaper. The National Health Fund also calculates financial value of the procedure of the very operation and wants to sell it to hospitals at the lowest cost as possible. Everything which happens with a patient later: post-operation treatment and dressings, possible complications, painkillers, disability pensions, sick leave – are covered by patients and the Social Insurance Company, not by the National Health Fund – explains prof. Witkiewicz. In many countries, for example, in Belgium, the so-called centres are set up, where there are 4 such robots which perform about 2 thousand operations a year, which makes depreciation expenses decrease. The prize of the robot is about 8.5 million zlotys (in 2010 year). The cost of an operation includes depreciation costs of 20-25 thousand zlotys. – If we performed about 500 of such operations a year, it would decrease the base costs – says the professor.
What is da Vinci robot?
Creating the robot is another phase of development of minimally invasive medicine. – A telemanipulator is a better definition of a 4-arm robot – explains prof. Witkiewicz. – It will not a movement without a surgeon’s control. Thanks to it we have a 10 times bigger picture in an abdominal cavity in 3D and HD. The equipment reduces a surgeon’s hands shaking, the end of arms’ devices maps movements of the wrist. Classical operations are difficult to perform, it is easier in laparoscopy and excellent conditions are created in operations by robotic surgery. On the one hand, the robot is prolonging of a doctor’s hands, but on the other hand – it gives extra possibilities to a surgeon and also supports his work. A surgeon, steering the so-called shifters, can reach to the most difficult places and also recognize the smallest vessels and nerves which is essential in operations. Prof. Witkiewicz emphasizes that in many countries the golden standard, for example, of an operation of prostate, is an operation with a robotic assistance. Application of the equipment allows for decreasing much loss of blood in a patient, reduces an amount of transfusion needed during an operation, shortens time of hospitalization and also guarantees less complications and a quicker recovery of a patient.
A robot for everything
A range of robotic operations is getting wider. The da Vinci robot can be used in various branches of medicine, beginning with general surgery, through laryngology, transplantation, urology, to oncology. In Wrocław, so far, no laryngologic operation has been performed with the usage of the da Vinci robot. – During the congress in Wrocław, the Italians showed us this kind of an operation and removing a woman’s mammary gland – says prof. Witkiewicz. – We want to develop operations also by a chest. Robotic surgery for oncologic patients is a big chance because surgery is still the most effective method of treating neoplasm, and also the cheapest instrument of this treatment.
Future of robotic surgery in Poland
In Wrocław there is the only da Vinci robot in Poland. All over the world there are 3.5 thousand of such equipments. To compare it, our neighbouring country – the Czech has about 10 thousand of them. In Belgium, Great Britain, and even in Czech robotic surgery is funded in 100 percent. In Poland operations with the usage of the da Vinci robot can be funded as a scientific venture. We do not still use the whole potential of the robot. It results from the fact that Polish surgeons, giving their opinions on operations, do not have such an experience, as those ones from foreign centres. For senior surgeons, who know anatomy perfectly, and are experienced, it is particularly helpful. They are not exhausted by an operation, and it also strengthens their possibilities by prolonging their hands. We are facing a lot of work whose purpose is to convince and balance its usefulness for a patient, considering surgical precision, which is essential in cancer illnesses – says prof. Witkiewicz.
-I have talked with the health vice-minister Krzysztof Łanda. I committed to present new prices of an operation with the robotic assistance of the da Vinci robot. Now we must gain means or sponsors in order to evaluate these operations on the basis of experience which we have gained. What is interesting, the first operations with the assistance of the da Vinci robot were performed on animals and mannequins, and also on cardboard boxes to which animals’ organs had been put, which brought a similar affect. For years we have been learning robotic technology, mainly abroad. We performed operations with assistance of experienced experts in this sphere. Today we are performing them on our own, we are getting fluent in them. The more we perform operations with the usage of the robot, the more effective and cheaper our operations will be – says the professor.
- I am disappointed by the fact that we can perform so few operations with the usage of the robot, and in this rush for improving the comfort of an operated patient we are still chasing the world. However, I think that this is the beginning of a road. At present we have 19 doctors from various spheres who know how to use this equipment. I hope that the congress will become a chance for strengthening cooperation in the future and will make it possible to popularize robotic procedures in our country. I am sure that one day robotic surgery will become a universal sphere in Poland. For now we are catching up with the world with the delay of 10 years. Progress is necessary. There is no retreat from robotics in surgery – concludes prof. Witkiewicz.
AA
„Niedziela” 13/2016