What is robotic surgery? Expert answers all our questions | DaVinci | Center of Excellence in Robotic Surgery and the Surgical Network of the Hospital Israelita Albert Einstein

To resolve doubts about this new technology, The Commerce spoke with the doctor Sergio Aráujo, medical director of the Center of Excellence in Robotic Surgery and the Surgical Network of the Hospital Israelita Albert Einsteinand one of the experts who traveled to Peru to instruct more than 70 Peruvian doctors from the Dos de Mayo National Hospital and the National Institute of Neoplastic Diseases (INEN) in this type of operations.

-“Robotic surgery” is a term that fuels the imagination, but what does it really consist of?

Robotic surgery is a form of minimally invasive surgery where the surgical incision – the cut made in the skin during the operation – is much smaller than that of conventional surgery. The difference between robotic surgery and laparoscopic surgery – another type of minimally invasive operation – is that in the former there is a surgical robot involved, so the surgeon is not next to the patient operating, but is sitting in a chair. surgical console that manipulates a series of robotic instruments that interact with the patient.

-What are the advantages of this surgery compared to the one we all know?

Robotic surgeries offer the doctor improved, three-dimensional vision with up to four times magnification, allowing for greater precision in instrument manipulation. The system even filters out the surgeon’s tremor and if he makes an imprecise movement, the robot automatically corrects it.

Another advantage is that there is greater accuracy in the movements of the surgical instruments, because these robotic systems are, unlike human ones, multi-articulated, which allows them to perform 360º turns that would be impossible with the limbs of a human. A final benefit is that since these robots were designed to also operate on battlefields, they can allow surgeons to operate remotely.

-What advantages does undergoing robotic surgery have for patients?

Regarding the patient, what is proven is that the greater precision of robotic surgery leads to less trauma and bleeding, which means a faster recovery. For example, after surgery such as radical prostatectomy for cancer – an operation to remove the prostate and nearby cancerous tissues – we usually hospitalize the patient for two to three days, but with robotic surgery we can discharge them the same day. So the advantages are less pain, a shorter hospitalization period and a faster return to activities.

-What are the limitations of this technology?

There are some. The main one is the cost, but there are also circumstances in which the benefits of performing robotic surgery – smaller incisions and faster recovery speed – are diminished so much that it may no longer be as convenient to perform it. Examples of these are patients undergoing multiple operations, who have very large tumors that require a large incision to remove them, or complex operations that require more than one incision to complete.

-Is robotic surgery much more expensive than traditional surgery?

Yes. Although it should be noted that what happened is that in almost all countries, including Brazil, robotic surgery began in the private health system. The situation is different in Peru, because this type of operation is available to all patients of the Comprehensive Health Insurance (SIS), and I recently had the opportunity to train the doctors of the Dos de Mayo Hospital and the National Institute of Neoplastic Diseases. about these procedures.

-How difficult is it for a surgeon to train to perform robotic surgery?

It is necessary for the surgeon to carry out certification. The training we do here at the Hospital Israelita Albert Einstein is done in two phases, a preclinical part – where the doctor does not have contact with the patient – ​​and a clinical part.

-What do these phases consist of?

The preclinical part has a strong theoretical content where the surgeon studies online everything about the stages and techniques of robotic surgery in a curriculum that lasts between 20 to 40 hours. This is complemented by a period of between 2 or 3 weeks in which they are trained in the system with virtual reality simulations in a similar way to those that airplane pilots undergo.

The clinical phase has three parts, the first is the observation of the surgery, where they learn how the robotic system performs in the operating room and what the layout of the equipment is. In the second part, the student becomes the assistant to the doctor who is performing the robotic surgery, becoming the doctor who is at the patient’s side during the operation in case any emergency occurs. Finally, the student serves as the main robotic surgeon, although observed by another more experienced colleague under a dual-console system, where the supervisor can observe the same as the examinee and intervene if necessary. Completing this phase will depend on the work carried out by the surgeon, but here in Brazil it is necessary by law for the surgeon to be instructed in 10 cases to complete the program.

-After three decades of its creation, robotic surgery has expanded to almost 70 countries, which now include Peru. How do you think the advancement of this technology will be in the coming years?

It is difficult to predict that, because there are countries where it proliferated quickly like the United States, while there are also other regions like Latin America and Asia where it spread less quickly due to costs. What I can say is that, in health systems where there was a high penetration of robotic surgery, it quickly replaced laparoscopic surgery. It is a trend that we have seen strongly in the last six years.

-Which means that when countries adopt robotic surgery, they do so with force.

I think so. I think it is important to talk about the population’s access to robotic systems. And while it is a relatively expensive technology compared to non-robot surgeries, the more robotic systems are produced, the lower the overall cost will be.

-A while ago you mentioned telesurgery, which allowed a surgeon to operate at a greater distance using the robotic system.

Telesurgery is an attractive, but more complicated, aspect of telemedicine that became popular during the pandemic, because it has additional requirements such as the need to guarantee the security of the broadband to operate, since any slowness in the internet connection It would cause a time difference between the movements performed by the surgeon and those that the robotic system subjects the patient to. Another aspect that complicates the situation is that if robotic surgery cannot be performed, a trained surgeon must be at the patient’s side to complete the procedure, so in my opinion it is necessary to determine what would be the advantage of performing the procedure. telesurgery on the patient, which is the most important part of medical care.

-I am a member of a profession that seems to be close to being supplanted by robots and AI, so I wanted to know if the same thing could happen to surgeons through autonomous robotic systems.

Autonomous systems exist completely experimentally and in 2024 a system was successfully tested that managed to make intestinal sutures in animals without human intervention. I believe this will be the future of these procedures, as well as an intermediate situation, where the robotic system can perform simple procedures, such as incisions, through the use of artificial intelligence under the supervision of a doctor.