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„It Is the Extension of the Surgeon”
Rolf Kreienberg is medical director at the university gynaecological hospital in Ulm. MEDICA.de spoke to the gynaecologist about high-tech helpers in operating theatres and game consoles.
MEDICA.de: Mr. Kreienberg, have you already conducted surgery with the aid of a robotic surgical system?
Rolf Kreienberg: No, but I had the opportunity to witness an uterus surgery which was conducted with the aid of Da Vinci. Da Vinci is the oldest and most popular robotic surgical system. It works with four arms equipped with micro instruments.
MEDICA.de: How did you like it?
Kreienberg: It is absolutly new to work that far away from the patient. What I especially liked about Da Vinci was the tremendous flexibility of the instruments. Ordinary laparoscopes, which are special endoscopes, do not have such a wide range of navigation. However, some colleagues miss the close contact to tissue. Conventional laparoscopy allows directing surgical instruments straight to the organs and you feel immediately where you can work more or less tight.
MEDICA.de: That is, when operating with the robot, the robot instead of the surgeon stands by the operating table. How is it navigated?
Kreienberg: Principally, it is comparable with a games console. The work is mostly done on monitor providing images of the operative field. The surgeon precisely navigates the instruments via joystick.
MEDICA.de: In view of the fact that surgical robots are very expensive – Da Vinci costs about one million euros – is the purchase of these high-tech helpers justified?
Kreienberg: That has to be examined, yet.
MEDICA.de: Are they only technical toys then?
Kreienberg: No, they are not, as they have some advantages to conventional laparoscopy. These are not only the flexibility of the instruments, but also the vision system which provides high-resolution three-dimensional images of the operative field.
MEDICA.de: Who is crucial to the success of a surgical procedure, the robot or the surgeon?
Kreienberg: Definitely the surgeon. Nobody but he conducts the surgery. And if there is an emergency, for example an abdominal haemorrhage, he has to be able to finish the surgery in a conventional way.
MEDICA.de: Surely, a lot of patients will not feel very comfortable about getting operated by a robot.
Kreienberg: Yes, that is true. You have to explain to them, that it is not the machine that conducts surgery, but the surgeon. Whether the surgeon stands directly by the operating table or three metres off, there is no difference.
MEDICA.de: Only few hospitals in Germany possess a surgical robot. When would you support the purchase of one in your hospital?
Kreienberg: Only if wide-ranging studies conclude that some robotic-assisted procedures attain better results than conventional laparoscopy.
The interview was conducted by Sonja Endres.