Robotic Surgery And Hepatopancreatobiliary Surgery?
Robotic surgery is a system where the surgeon sits at the surgeon’s head and performs the surgery remotely, and in abdominal surgeries, after the trocars are placed in the patient’s abdomen as in laparoscopic surgery, the cutting, burning and suturing tools to be used in the surgery are mounted on the Robot arms. An assistant surgeon stands next to the patient during the surgery.
Robotic surgery is arguably the most groundbreaking and perhaps the most competent surgical innovation of the twenty-first century. Born from military technology, developed by industry and advocated by surgical pioneers, robotic surgery is a comprehensive treatment technology that increasingly enables the implementation of surgical intervention robotic systems as an alternative to laparoscopy to perform a wide variety of surgical procedures for both benign and malignant diseases. This method continues with the surgeon’s robotic connections being directed from a computer-aided console. Robotic surgery is considered one of the most advanced techniques among minimally invasive operations, i.e. operations performed with small incisions. Some of the surgeries performed with Robotics in General Surgery are given in Table 1 below.
Table 1: Most Common Surgeries Performed with Robotic Surgery
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Robotic surgery is an increasingly common method used in Hepatopancreatobiliary (HPB) surgery, as in many branches of surgery today. This method offers some advantages over traditional open surgery, providing better results for patients.
Robotic Surgery’s Place in HPB Surgery
Robotic surgery provides the surgeon with a three-dimensional, high-resolution image, allowing him to perform more precise and less invasive procedures. Thanks to the robot’s small and mobile arms, it is easier to move in narrow areas and the risk of damaging surrounding tissues is reduced.
Advantages of robotic HPB surgery include:
- Smaller incisions: Since it is performed with smaller incisions than traditional open surgery, postoperative pain is less and recovery time is shorter.
- Less bleeding: Robotic surgery has less bleeding, which means less need for blood transfusions.
- Better cosmetic results: Thanks to the smaller incisions, surgical scars are less noticeable.
- More precise movements: Thanks to the robot’s small and mobile arms, the surgeon can make more precise movements and cause less damage to surrounding tissues. Longer surgery: Using the robot’s arms, the surgeon can perform longer surgeries, allowing more complex procedures to be performed.
Preparing for Robotic Surgery
Preparation and training are key to incorporating robotic surgery into clinical practice and becoming a successful robotic surgeon. Before beginning any robotic surgery, the surgeon must (1) understand the robotic surgery system, its features and function, and the optimal instrument selection and use; (2) establish a safe and efficient robotic operating room; (3) review the necessary steps of the procedure and the specific steps of the robotic approach; and (4) be familiar with the current literature on robotic surgery.
When is Robotic HPB Surgery Used?
Robotic surgery can be used for liver tumors, gallbladder surgeries, pancreatic tumors, and many other HPB diseases. However, robotic surgery may not be appropriate for every patient. Your surgeon will perform a detailed evaluation to determine the most appropriate treatment method for you.
Robotic Pancreatic Surgery
Pancreatic surgeries, including pancreaticoduodenectomy (PD) and distal pancreatectomy, are considered the most complex and technically challenging abdominal procedures performed by general surgeons. The situation is no different when the robotic approach is applied. Minimally invasive pancreatic surgery began in 1994 with laparoscopic whipple surgery by Michal Gagner. Later, minimally invasive surgery continued with laparoscopic distal pancreatectomy and laparoscopic enucleation.
Initially, discouraging results were obtained, but minimally invasive pancreatic resections continued. Robotic pancreatic surgeries also came into play. Today, distal pancreatectomies are performed minimally invasively laparoscopically or robotically in clinics with the opportunity. However, there are still controversial situations in Whipple surgeries.
Prof. Dr. Kemal Dolay’s approach in pancreatic tumors is Laparoscopic or Robotic resection in distal pancreatectomies if there is no locally advanced tumor. If locally advanced and multiple organ resection is required, it is open surgery for radical oncological surgery.
In pancreatic head tumors, if the tumor is at a very early stage, the minimally invasive method is preferred, while open surgery is preferred in patients who have received neoadjuvant chemotherapy and who require additional vascular resection.
Robotic Liver Resections
Since the first laparoscopic liver resection was reported by Reich and colleagues in 1991 for benign liver disease, numerous minimally invasive techniques have been described in liver surgery. Studies have shown that minimally invasive liver surgery is safe and feasible and can be performed safely for both benign and malignant diseases using fully laparoscopic, hand-assisted laparoscopic, and robotic techniques. A wide range of minimally invasive surgeries, from liver metastases to major liver resections such as trisegmentectomy, have been shown to improve perioperative patient outcomes. However, there are limitations to laparoscopic liver resections due to tumors in difficult locations (posterior liver segment tumors), flat laparoscopic instruments, and surgeon hand fatigue during long surgeries. With the introduction of the robot in liver surgery, some of these limitations have been reduced and made more applicable.
What Liver Surgeries Can Be Performed with a Robot?
Robotic surgery can be used in various procedures such as removal of liver tumors, treatment of liver cysts and liver transplantation.
-Removal of liver tumors (hepatectomy): Robotic hepatectomy allows for more precise and less bleeding removal of liver tumors: Right-left hepatectomy, segmentectomy, metasatzectomy
-Treatment of liver hydatid and neoplastic cysts: Robotic surgery allows for safer removal or drainage of neoplastic cysts and parasitic cysts such as hydatid cysts of the liver.
-Liver transplantation: Robotic surgery can also be used in living donor liver transplantation procedures. This method provides less blood loss and a faster recovery process.
Prof. Dr. Kemal Dolay performs robotic resections in suitable patients for liver tumors. The decision on which surgery to choose is made by informing the patient, and if robotic surgery requires compromising oncological surgical principles, open surgery is preferred for a RADICAL resection.