Precise robot-assisted surgery in thoracic and abdominopelvic region
Until a while ago, many surgeries had been performed under thoracotomy or laparotomy with long incision. These surgeries generally provide the patients with great burden and are relatively often accompanied by massive bleeding. The patients are not able to get up soon after these surgeries because of post-operative severe pain. After that, thoracoscopic or laparoscopic surgeries have been introduced. Thoracoscopic or laparoscopic surgeries are performed with a kind of several tubes, called as trocars inserted. Laparoscope (camera) and instruments including forceps, scissors, and graspers are inserted through the trocars. Thoracoscopic or laparoscopic surgeries are performed with small skin incisions and provide the benefits of less bleeding and postoperative pain, and earlier convalescence. On the other hand, laparoscopic surgery requires high technical skills because instruments that are straight without any joint at the tip are manipulated with difficulty under laparoscopy. Especially suture techniques in the body in the laparoscopic surgery require even more difficult manipulation.
After that, in 2012, the robot-assisted surgery by using the Da Vinci surgical system (Photo 1) for prostate cancer has been approved for the first time in insurance system in Japan. The robot-assisted surgery has many advantages. First, as the instrument has the joint function and moves like a human wrist, the surgeons are able to manipulate the instruments delicately.
Secondly, as it has the function to eliminate hand-shaking even though the hands of the surgeons may shake and also the setting of motion scale, for example, an instrument actually moves only 1 cm when the surgeons move their hands by 3 cm, the surgery is performed delicately. Camera and instruments can reach the depths in a body and complicated handling such as sutures inside the body can be also done precisely.
In our hospital, the Da Vinci surgical system has been introduced in 2011. The robot-assisted surgical system is rapidly spread nationwide and have been additionally approved for malignant diseases of lung, mediastinum, esophagus, stomach, pancreas, rectum, kidney, bladder, uterus, valvuloplasty in a heart, and pelvic organ prolapse in the insurance system in Japan.
The Da Vince surgical system is used in 70 countries over the world. The surgical robot system, hinotoriTM (Photo 2), that was developed in Japan has been also introduced in our hospital. Besides, other new robot surgical systems have been developed and the robot-assisted surgeries will spread and develop more from now on.
Robotics technology support surgery as intended by the surgeon
In the field of orthopedic surgery, surgical robots have been introduced for arthroplasty and spine surgeries. In these surgeries, the position and direction of the artificial joint implants and screws used to fix the spine are very important because they determine the outcome of the surgery, however until now, these techniques were relied on the surgeon’s experience.
The robots (Photo 3: Mako and Photo 4: CORI) currently in use at our hospital for hip and knee joint replacement surgery are as accurate as or more accurate than the navigation systems used in the past. In addition to robotic-assisted osteotomy with greater precision, it is now possible to evaluate and fine-tune ligament balance. Therefore, good clinical results are expected with this technology.
In addition, a robot for spine surgery (Photo 5: Cirq), unlike navigation, is expected to provide more accurate and safer surgery by guiding the screw direction when they are inserted.
As of January 2024, we are the only national university hospital in Japan with surgical robots for hip, knee, and spine surgeries. In this special feature, specialists in each field will explain the details.