What is Robotic Surgery?
Robotic surgery is an emerging new and exciting technology. In short, robotic surgery means performing surgery using a surgical system called a robot. This procedure is performed under general anesthesia and therefore the patient sleeps and does not feel pain.
We use the robotic surgery system called “Da Vinci SI” in our hospital. This system consists of roughly 3 parts. These are the surgeon console, the robotic unit and the bedside unit.
Da Vinci SI System And Parts
The surgeon who will perform the surgery sits on the unit called the surgeon console and directs the robot arms from there to perform the surgery. Thanks to the high-resolution imaging system of the surgeon's console, it provides a very clear three-dimensional image to the surgeon.
Robot console
He controls the robot arms by placing the fingers of his right and left hands in specially designed places in this unit and making some movements.
Position of surgeon's fingers on robot console
The robotic unit is controlled by the assistant surgeon, who is at the patient's bedside and assists the console surgeon.
The state of the instruments attached to the robot arms in the robotic unit
There is a monitor providing high resolution images in the bedside unit. The assistant surgeon assisting the console surgeon sees the operation image here and thus helps the console surgeon.
bedside unit
At the beginning of the surgery, the surgeon makes small incisions in the skin and inserts working channels called trocars to insert the robot's instruments into the body.
Placement of trocars in a pediatric patient
He then places the robot instruments inside the trocars.
Comparison of robot instruments used for different purposes (left) and their size (right)
These instruments are attached to the arms of the robot. The surgeon directs the movements of the robot's small instruments with his hands. Robotic arms and instruments imitate the surgeon's movements on the console.
Comparison of the mobility of one of the robotic instruments with the movements of the human wrist.
The robotic system provides freedom of movement in 7 axes, thanks to its mobility, and can perform movements that the human wrist cannot do, by turning 540 degrees around itself.
What are the urological robotic surgeries performed in urology practice?
The patient group suitable for robotic surgery in urology practice is especially adult cancer patients. Robot-assisted surgeries in urological surgery;
1st group surgeries; cancer surgeries and reconstruction (reshaping) surgeries of prostate, bladder, kidney and adrenal glands performed in adults.
2nd group surgeries; pediatric urology surgeries. These; correction of urine leakage, which we call reflux, from the urinary bag called the bladder to the urinary canal called the ureter; Again, the robot is successfully used in the narrowing of the ureterovesical junction between the bladder and the ureter and the ureteropelvic junction between the kidney and the ureter, and in bladder augmentation surgeries called augmentation.
When did robotic surgery start to be used in children?
The first robotic urological surgery performed in children was pyeloplasty and was performed in 2002. Since then, the successful implementation of many urological interventions such as robotic pyeloplasty, nephrectomy, heminephrectomy, ureteral reimplantation and augmentation has increased the popularity of robotic interventions in children.
In which centers are robotic urological surgeries performed in our country?
Robotic urological surgeries performed in children are not yet very common surgeries in Turkey and are performed only in a few centers in our country. With the experience I gained thanks to the robotic pediatric surgeries that I started in July 2014, I am in an effort and effort to deliver this treatment to more children. All the robotic pediatric urological surgeries I mentioned above and described in the current literature are successfully performed by me. So far, I have operated 29 pediatric patients with a robot. According to my experience, children recover faster and return to their daily lives faster with these surgeries compared to open surgeries.
