Robotic Surgery

“Da Vinci Robotic Surgery” is one of the most important surgical methods that have developed in cancer surgery and spread rapidly in the world in the last 10 years. Memorial Şişli Hospital da Vinci Robotic Surgery Center Physicians gave information about the treatment of urological cancers with robotic surgery.

“Da Vinci Robotic Surgery”, which is performed by following all principles of cancer surgery with minimal incision, and which damages normal tissues at a minimum level, provides the opportunity to operate under a three-dimensional imaging by enlarging the tissues 20 times their real size.

With Da Vinci technique, the best results related to cancer control are obtained, while undesirable complications that may happen due to surgery are also minimized.

Urological cancers have an important place among all types of cancer. When skin cancers are evaluated separately, the most common type among internal organ cancers is “prostate cancer”. Apart from prostate cancer, the most important type of cancer that develops due to smoking is “bladder tumors”. Thanks to the developing medical technologies, kidney cancers are diagnosed more frequently and can be caught and treated in small sizes without any spread. In cancer treatment, there has been a tendency towards non-surgical methods because of the reasons that operations are difficult to accept by patients, loss of function or high postoperative disability and mortality rates. In addition to better understanding of the anatomy in recent years, surgical techniques have been developed that give less pain to the patient, reduce undesired conditions that may develop due to surgery, shorten the recovery time after surgery, and return the patient to his daily life faster. Besides, thanks to the dizzying developments in anesthesia and intensive care facilities, the place of surgical treatment in urological cancer treatments has gradually increased.

In surgery, “da Vinci Robotic Surgery”, which is accepted as the top peak of technology and provides comfort to the patient during and after the surgery, is the most used method in urological cancers. With the da Vinci method, patients can adapt to social life in a short time, and the disadvantages of open surgery are minimized.

Risk of loss of sexual function decreases in prostate cancer

Prostate cancer is the most common type of cancer used by robot technology all over the world. As a result of the frequently performing of the blood test called PSA test and the development of prostate biopsy technique, more prostate diagnoses are made and tumors are also caught in the curable period.

An important change in the diagnosis of prostate cancer; The age of determination of the disease is carried to younger ages who do not want to lose their sexual functions. As a result of all this, patients tend to search for the perfect tumor control and treatment that minimizes loss of urine and sexual function that may develop due to the operation. Robotic surgery is the surgical method that responds to this search of patients. In robotic surgery, which is rapidly spreading all over the world, cancer control in prostate cancer surgeries is at least as much as provided by open surgery, and surgery-related blood loss and blood transfusions are practically absent.

Besides since the nerve structures that control sexual functions and the muscle structures that fulfill the urinary retention function can be protected much better; Undesirable conditions such as urinary incontinence and loss of sexual function that may develop after surgery are less common, and patients can return to work and social life in a shorter time.

Kidney tumor surgeries can be done through several holes

With the use of developing and expanding technologies, the diagnosis of kidney tumors can be made at an early stage and at a very small size. If kidney tumors are smaller than 4 cm, they can only be treated by removing the tumor tissue. That is, there is no need to take the patient's kidney. The aim is to protect the kidneys as much as possible. Rotobic surgery; Due to the partial removal of some of the rib bones during open surgery, it eliminates very painful conditions that may develop in the postoperative period and allows patients to recover faster due to the small incision site. In some types of kidney cancers, all of the channels that carry urine to the bladder along with the kidney and the bladder tissue in the corner where this channel opens into the bladder should be removed together. This surgery is performed with an open method either through a large incision or a second incision is needed in the groin area to remove both kidney and bladder parts. In robotic surgery, the entire operation can be performed with the help of a few holes, unwanted effects due to large incisions can be prevented or minimized.

Removing bladder is an important social problem for the patient

The most effective treatment for cancers that have advanced to the deep layers of the bladder or have a risk of progression and have leakage to non-bladder tissues is surgical removal of the bladder. In addition, the lymph nodes, which are at risk of bladder cancer, are cleaned and cancer control is tried to be provided in the best way. However, the bladder's urine storage and urine emptying functions should also be replaced. For this, various surgical methods are used, each with different advantages and disadvantages. First of all, the channels that allow the urine produced in the kidneys to be transmitted to the bladder can be opened directly to the skin of the abdomen by using the 'intermediary' intestine piece. In both cases, the patient will have to stick a bag to the body for the rest of his life. In order to eliminate the need for bags, methods made from the large intestine and opened to the skin of the abdomen were developed. Here, the opening in the skin of the abdomen does not pass urine and therefore patients do not have to wear a bag. However, the urine accumulated inside should be emptied by inserting the catheter at certain intervals. This method does not fully meet the expectations of the patients. Patients' expectation is that even if their bladder is removed, their new bladders made from the intestines are connected to the normal urinary tract, they can retain urine after surgery, and they are able to perform urine emptying in the normal way without the need to insert a catheter or bag. In addition, sexual function losses are minimized.

ARTIFICIAL BLADDER FROM THE INTESTINE VIA da VINCI

Considering all the operations, the most difficult performed open operations are the removing of bladder, the removal of the lymph nodes and reconstruction of the bladder from the intestines. Some of the surgeons with serious open surgery experience can perform this surgery semi-robotically. In this technique, the robot is used while removing the diseased bladder and lymph nodes, and at the same time, the nerves that provide sexual functions and the muscle structures that provide urine retention can be protected much better. The rest of the surgery; The construction of a new bladder from the small intestine and the connection of the urinary canals to this new bladder is made through open surgical method. Recently, all stages of the surgery have been started with robotic surgery. Thus, besides the protection of nerves and urinary retention mechanism with sexual function, the loss of fluid from the intestines, damage of the intestines, abdominal and intra-abdominal organs due to airborne microorganisms and foreign bodies are reduced. In addition, since there is no need for large incisions, there is no need for a second operation to hurt the wound, heal the wound, open the wound and close it. As the intestines are also protected with the least amount of harm, patients recover faster and experience fewer problems during this period.

Patients with testicular tumors be saved from the risks of open surgery

The main location of testicular tumors are the lymph nodes around the large vessels in the abdomen. Today, the lymph nodes of patients at certain risk groups are removed surgically against the possibility of this splash. Patients can be treated with cells that are supposed to spread to the lymph nodes by chemotherapy. In addition, patients can be kept under strict follow-up without any treatment. If it is decided that the disease recurred during the follow-up period, it can be controlled by chemotherapy. Because the preventive effects of cancer drugs given to prevent the spread of testicular tumors, such as infertility or causing other cancers in the long term, bring the surgical treatments back on the agenda. Surgery to be applied in these patients is also a serious surgery. In open surgery, the abdomen is opened from the lower end of the chest bone to the point where the pelvis joins, also known as the "board of faith", the patient's intestines are taken out of the body and the lymph nodes around the large vessels are removed. Then the intestines are placed back into the abdominal cavity and the incision is closed. The patient's recovery after surgery may slow down due to reasons such as the release of the intestines from the place where they stick, loss of fluid and heat from the intestines, the risk of inflammation of the intra-abdominal membranes and organs, and foreign bodies. In addition, due to the large incision, the need for reoperation may occur for wound inflammation, wound herniation and wound opening, and closing the opened wound. Robotic surgery can eliminate or minimize these disadvantages. With robotic surgery, the neural network that allows the semen around the large vessels to be thrown out can be better looked and protected and the risk of loss of this function can also be reduced.

Prepared by Memorial Medical Editorial Board.