Robotic surgery
"The Da Vinci robot provides good vision and excellent instrument handling. With this technique, the scar is minimal and the risk of bleeding is less".
DR. BERNARDINO MIÑANA DIRECTOR - PERSON IN CHARGE. UROLOGY DEPARTMENT
What is robotic surgery?
Robotic surgery overcomes the limitations of conventional laparoscopic surgery by making surgical procedures more comfortable and more precise, especially the most complex operations and those that are difficult to access.
Clínica Universidad de Navarra, always at the forefront of new diagnostic and therapeutic systems, has had the Da Vinci robot since 2010 to perform minimally invasive procedures.
In addition, it has introduced the Da Vinci Single Port (SP) surgical robot at its Madrid campus, the most advanced technology in minimally invasive robotic surgery.
With a single incision measuring between 3 and 5 centimeters, the camera and up to three articulated instruments are inserted, with high-definition three-dimensional vision and a range of motion greater than that of the human hand. Depending on the clinical case, the robot’s design also allows the camera and instruments to be introduced through the body’s natural orifices, thereby avoiding any incision.
Greater surgical precision, a less invasive procedure, elimination of the surgeon’s natural hand tremor, and improved visualization of the anatomical field being operated on are the main advantages the Da Vinci robot brings to surgeries performed with this advanced system.
The medical specialties for which the Da Vinci robot is indicated include: urology, certain gynecologic conditions, general surgery, cardiothoracic surgery, pediatric surgery, otolaryngology (ENT), and select neurosurgical indications.
When is robotic surgery indicated?
Da Vinci robotic surgery is used in a multidisciplinary way to treat a range of conditions:
- In Urology: Radical prostatectomy, partial nephrectomy, ureteral reimplantation, pyeloplasty.
- In Otolaryngology (ENT): Surgery at the base of the tongue for obstructive sleep apnea (OSA), transoral oncologic surgery for tumors of the oropharynx, supraglottic larynx, and hypopharynx (known as TORS), transaxillary remote-access thyroid surgery, and transoral surgery of the parapharyngeal space.
- In Gynecology: Hysterectomy, tubal reconstructions, myomectomies, uterine tumors.
- In General Surgery: Colon and rectal surgery, bariatric surgery, hepatobiliary-pancreatic surgery, and surgery of the lower third of the esophagus.
- In Cardiothoracic Surgery: Coronary artery bypass surgery, mitral valve repair, atrial septal defect repair, tricuspid valve repair, and mediastinal and lung surgery.
Would you like to know more about this treatment?
If you would like more information, please do not hesitate to contact our team.
Learn more about Da Vinci® Robotic Surgery
How robotic surgery works
It offers greater precision and vision, less invasiveness and suppression of the surgeon's natural hand tremor.
Da Vinci® robotic surgery is performed with specially designed instruments that are small in size and very precise in their handling. It allows working with a perfect visualization of the area and gives greater precision to the surgeon.
It consists of three main elements:
Patient trolley. It integrates the four arms that hold the instruments with which the patient is operated. One of them carries the camera that transmits to the surgeon's console the images of the internal anatomical region to be operated. The nursing personnel working in the sterile area, close to the patient's cart and the operating table, exchange instruments and endoscopes as needed.
Surgeon's console. Equipment control center, located outside the sterile area, a few meters from the operating table. From it, the surgeon controls, through two controls or manipulators, the instruments and an endoscope that offers images in three dimensions.
It also has pedals to control part of the instruments with the feet.
Its design imitates the natural alignment of the eye, hand and instruments of open surgery, optimizing the coordination of hands and feet. The three-dimensional vision, with depth of field, and an optic of up to 12 magnifications, much higher than that of laparoscopy, provides greater precision and the ergonomics of the system offers the surgeon the same dexterity of movement as in open surgery.
Vision trolley. It integrates the image processing equipment, whose configuration is handled by one person outside the sterile field of the operating room. A touch screen monitor is placed in this component.
Advantages of robotic surgery
Robotic surgery replaces the limitations of conventional laparoscopic surgery by making surgical interventions more comfortable and precise, especially for the most complex and difficult to access procedures, such as radical prostatectomy.
The Da Vinci® Surgical System is a computer-assisted robotic system that extends the surgeon's ability to operate in a less invasive manner.
It provides greater surgical precision, a less invasive procedure, elimination of the surgeon's natural hand tremor, and better visualization of the anatomical field being operated on.
The instruments are designed in such a way as to obtain 7 degrees of freedom of movement, practically similar to the mobility of the surgeon's hand, unlike conventional laparoscopic surgery, which allows only 4 degrees.
Blood loss during the operation, and therefore the need for transfusions, is 25% below the requirements of open surgery, a percentage similar to that of the laparoscopic procedure.
Clinical use in Urology
The prostate operation with the Da Vinci® robot
consists of a radical prostatectomy (aimed at removing prostate tumors), which is the most frequent surgical intervention performed with this system. But it is also used in partial nephrectomy, ureteral reimplantation, pyeloplasty.
The advantages over conventional techniques lie in the recovery of mictional control within the first three months, faster than with laparoscopic or open surgery, due to the greater precision in dissecting the tissues.
Another of the most frequent complications in prostatectomy patients is sexual impotence. When a technique is used to preserve the erector nerves, and this is achieved in more patients with robotic surgery, it favors more effective conservation of sexual potency and greater integrity of the sphincter of the urethra, thanks to a much finer and anatomical dissection.
The hospital admission required after a robotic radical prostatectomy operation is also similar to that of laparoscopy, located between 2 and 3 days, as opposed to 5 days for conventional surgery. The operation time with the Da Vinci® System is extended by 4 or 5 hours, and in all cases general anesthesia is applied.
Clinical use in Otorhinolaryngology
We are pioneers in surgery for thyroid pathology, OSAS and larynx cancer with the Da Vinci® robot.
Transoral robotic surgery is performed with specially designed instruments that are small in size and highly precise in their handling. It allows working with a perfect visualization and millimetric accuracy.
It is used to remove tumors of the tonsil, base of the tongue, hypopharynx and larynx, as an alternative to laser surgery or open surgical procedures such as thyroid pathology.
Thanks to Da Vinci® robot technology, the removal of these tumors is performed more extensively and often in one piece, as opposed to the resection of the tumor in fragments performed with other surgical methods.
This surgery offers the patient a new surgical treatment alternative, with rapid healing and functional recovery, along with good treatment results.
La Clínica is the first Spanish hospital center that has operated on thyroid pathology using this robotic technique. The main benefit is aesthetic, since it avoids the cervical scar of conventional thyroid surgery by making a single incision in the axilla.
The transaxillary robotic technique is indicated for the removal of nodular goiter, follicular thyroid carcinomas no larger than 2 cm without extracapsular extension and parathyroid adenomas (hyperparathyroidism).
In a pioneering way in Spain, the Clinic is expert in the surgical treatment of other pathologies with robotic surgery: obstructive sleep apnea syndrome, partially removing the lingual tonsil through the oral cavity (transoral), and larynx cancer with transoral approach.
Other clinical uses of robotic surgery
In Gynecology, the technique is applied in hysterectomy, tubal reconstructions, myomectomies and uterine tumors.
In different pathologies of General Surgery, the Da Vinci® robot is used in colon and rectum surgery, bariatric surgery, hepato-bilio-pancreatic and surgeries of the lower third of the esophagus.
As for cardiothoracic surgery, robotic surgery is applied to aorto-coronary bypass operations, mitral repair, interauricular communication, tricuspid valve repair and mediastinum and lung surgeries.
It is also applied to some pediatric surgery and neurosurgery interventions.