In the end, Svetoslav Dyakov is a polite host; the head of robotic urology at the University Hospital of Augsburg allows professional soccer player Raphael Framberger from FC Augsburg to come up again after a clear lead. Many people have gathered in the entrance hall of the university hospital, they all want to know what a robotic surgical system can do, but of course everyone also wants to see the penalty shootout. Dyakov’s son has built a goal, a field and even a spectator stand out of Lego bricks, on which there is now a small ball. The senior doctor, in this case the professional, and the medical layman Framberger, try to control the surgical robot in such a way that the… A grasping forceps attached to the gripping arm – a typical surgical instrument – pushes the ball into the miniature goal. The final score is 3-3, thanks to Dyakov’s indulgence.
Da Vinci is the name of the robot assistance system, of which there are now more than 8,600 examples in operating rooms worldwide. An operation with such a robot with four gripping arms takes place every 13 seconds. The University Hospital in Augsburg is presenting the system to the public and its patients in the entrance hall on Thursday and Friday. In urology, gynecology, general, visceral and transplant surgery, the Augsburg doctors use the system, which promises precise work for the doctor and a gentle procedure for the patient. Many people now explicitly go to clinics that have one of the 1.6 million euro devices in operation. Others are worried about the technology, which is no longer so new. The university hospital wants to allay your fears. And with the two days of action, it also wants to advertise that patients do not have to travel to Munich or Ulm for robot-assisted procedures.
The surgeons use the robot to operate on people who have cancer, for example, whether in the prostate or in the uterus. Dyakov emphasizes that in the future patients will not have to decide whether they want to be operated on by a surgeon or a robot. You would be operated on by a surgeon who works with a robot. The Da Vinci, developed by a US company, consists, among other things, of a control console that is not located directly on the operating table. The surgeon who operates the operating unit, i.e. the robot with the gripper arms, sits there via a control unit for the right and left hand as well as pedals and a 3D monitor.
Dyakov’s colleagues Florian Sommer from the Clinic for General, Visceral and Transplantation Surgery and Thomas Jung from the Clinic for Gynecology and Obstetric Medicine also emphasize that this has several advantages. This allows doctors to work much more precisely than directly on the patient, with an image of the surgical area that is enlarged up to ten times. “You can see structures that you wouldn’t be able to see with the naked eye,” explains Dyakov. The robot’s gripping arms have significantly better mobility than a human’s wrist, especially since the system can compensate for tremors or jerky movements – which is particularly important for procedures that last many hours and are extremely strenuous for the surgeons.
Patients can expect little pain, little blood loss, precise incision and quick recovery after surgery. On average, patients in urology stay on the ward five days less than with conventional surgery. And they leave the hospital with a scar that doesn’t run the length of their stomach, but is hardly visible to the layperson at first glance. Complications are also statistically significantly less common than with open operations.
Designed for soldiers in crisis areas
Dyakov explains that medical technicians in the US Army began developing robots in the 1980s in order to be able to operate remotely on soldiers in crisis areas. The world’s first robot-assisted prostate removal, for example, took place in the urology department of the University Hospital in Frankfurt am Main in 2000. Around 65 percent of all prostate removals in Germany are now operated with robotic assistance, and at the University Hospital in Augsburg the figure is even 75 percent.
Doctors and technicians are constantly developing the system further. The latest generation of the Da Vinci robot has tactile feedback, says Dyakov. Through the controller, the surgeon feels the resistance of the tissue through which he is cutting. “It’s a similar feeling to actually operating with your hand.” Research is also being carried out with artificial intelligence; according to Dyakov, there have already been initial successes in so-called “telesurgery”: operations in China were controlled by operators from Europe.