ROBOTIC SURGERY | ASSOCIATE PROF. CENK ACAR
ROBOTIC SURGERY






What is robotic surgery?
da Vinci Robotic Surgical System allows performing surgical operations by the surgeon with minimal incisions. In addition to the advantages of laparoscopic systems, it is known with sensitivity feature also together with the ability of motion thanks to the three dimensional imaging technology. Based on these features, it was started to be used in our country also starting from mid 2000s. da Vinci Robotic Surgical System has three separate sections:

3 Dimensional Camera
da Vinci robotic surgical system has two cameras with high resolution to provide images separately in both eyes. This way, the surgeon makes the operation under 3 dimensional images on the console with a feeling of depth, just like with our eyes. Furthermore, operation area is magnified by 10 to 12 times with these cameras.

Surgical Instruments
Instruments found on the arms of the robotic surgery system Instruments placed on the robotic surgical system can be defined as small instruments capable of moving freely on 7 steps. The tips of these instruments can rotate by 540 degrees around their axes thanks to the system called ‘endowrist’ (imagine you can rotate your wrist approximately two times around its axis) and can simulate the wrist movements of the human hand. Thanks to these instruments, great easiness is provided for the surgical interventions within very narrow and deep spaces. The robotic surgery system never transmits the potential tremor of the surgeon’s hands at the moment of the procedure to the instruments with the “tremor reduction” feature. Furthermore, such instruments never operate outside the surgeon’s control.

Surgical Console
In the robotic surgical system, surgeon works on the console in sitting position, and sees the operation site in three dimensions, and gives commands using the camera and other instruments with the help of his/her hands and feet. These commands are performed synchronously. Surgeon carries out the operation in sitting position and performs even very long operations without getting tired. Operations in the robotic surgery are carried out through small pipes called “port” just like in laparoscopic surgery. One of the arms of the robot holds the camera while other arms hold instruments. A surgeon standing by the patient during the operation helps the surgeon at the console.

What are the areas of use for Robotic Surgery?
Robotic surgery can be used in all the branches and procedures that laparoscop0ic surgery is used. Therefore, it is commonly used in gynecology, cardiovascular surgery, general surgery and urology. In the urologic diseases:

• Radical cystectomy applied for prostate cancer,
• Partial nephrectomy for renal cancer,
• Pyeloplasty for renal outlet obstruction (Uretero-pelvic junction obstruction)
• In radical cystectomy for bladder cancer

Who is suitable for Robotic Surgery, and what are the advantages?
Although there are many treatment options in localized prostate cancer, surgical removal of the prostate (radical prostatectomy) is accepted as the golden standard. This method can also be applied as a laparoscopic procedure with the assistance of a robot with the technological developments of the last 10 years. Studies have shown that robot provides cancer control comparable to open surgery in the hands of experienced surgeons.

Preservation of nerves controlling hardening in suitable patients in all the three radical prostatectomy methods (open, laparoscopic and robot-assisted) contributes to the sexual function and continence in the postoperative period. In this regard, robot-assisted procedures give somehow better results as compared to open and Bu laparoscopic. However, robotic surgery has the advantages including going back to work early and cosmetic. However, it must be kept in mind that experience is important, not the technology to treat the patient successfully, and the method that the surgeon is successful must be preferred.