Esophageal cancer: increased patient safety thanks to the ”Da Vinci“ surgical system

Interview with Professor Jürgen Weitz, Director of the Clinic and Polyclinic of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus at the Technical University Dresden

Nowadays you will find more and more robots in operating rooms which on the one hand support the surgeon and should also increase the safety of patients. One of these systems is the "Da Vinci" system that has already been used for different surgical methods for several years. Among other things also in treating esophageal cancer. But does it hold its promise?


Photo: Jürgen Weitz

Prof. Jürgen Weitz; © Jürgen Weitz/ private

In this interview with, Professor Jürgen Weitz explains what differences to other methods of treating esophageal cancer exist, what the biggest advantages and disadvantages of the system are and which people need to be trained to use it.

Professor Weitz, how does surgery for patients with esophageal cancer with the "Da Vinci" surgical system differ from the previously conventional approach?

Jürgen Weitz: What makes esophageal cancer surgery so unique is that you need to perform a portion of the surgery inside the ribcage. This is where I expect special advantages from the minimally-invasive method. In open surgery, the intercostal spaces need to be spread – and this is very painful for the patient.

One study has shown that patients benefit from so-called thoracoscopic surgery, that being a minimally invasive surgery without the use of a robot. However, it is technically quite difficult to conduct the surgery in the ribcage minimally-invasive because it’s hard to maneuver around the ribs with the long and inflexible instruments. This is the big advantage of the robot because it can also be perfectly maneuvered three-dimensionally inside the ribcage.

Why are you just now performing esophageal cancer surgeries with the "Da Vinci" surgical system?

Weitz:Worldwide or nationwide we were not the first physicians to do this but just in the newly-formed German states. Why is that? Why does this take a relatively long time? Because so far this is one of the most intricate surgeries we do and you need to carefully approach these types of complicated surgeries. After all, patient safety is always the top priority. That means we can only perform those types of surgeries where we are absolutely sure that we are not putting the patient at risk. It simply takes longer for surgical technology to develop and to assemble the team. This is a gradual process.
Image: Esophageal Cancer

It is technically quite difficult to conduct the surgery in the ribcage minimally-invasive because it’s hard to maneuver around the ribs with the long and inflexible instruments; © edesignua

What pros and cons do you see as a surgeon with this surgical system?

Weitz:The advantages are for the Patient: You hope that the pain and the postoperative complications, especially pneumonia can be reduced in patients. Thanks to the smaller incisions, the patient has less pain, is able to breathe better and cases of pneumonia are reduced.

However, one disadvantage of this system is the lack of haptic feedback. That means you don’t feel what you do with your hands like you normally would, you only see it. Having to learn this is a real disadvantage. The big hope is that new robotic surgical systems are able to compensate for this in the future. Another essential drawback is the cost of this system.

Who needs to train for using the robot and how long does it take for it to be applied?

Weitz: Aside from the surgeon, the first and second assistants and the OR nurses need to be trained. At this point, this is a well-established system that is also tightly monitored by the company that produces the robotic surgical system. You are gradually and slowly introduced to the robot. My personal big advantage is the fact that I undertook special training to perform cancer surgeries in the U.S. We already had one of these robots there in 2002 and I was able to work with it. I have therefore been familiar with this system for several years. That said, those colleagues that are just now starting their practical training are introduced to the system in a very structured manner. There are virtual training opportunities and training courses where the colleagues learn together.

As you have mentioned already, the use of this surgical system is very expensive. Critics claim that this has no effect on the length of hospital stays for example. Is that true?

Weitz: This is a question where you need to distinguish between the types of surgeries. The advantages can be entirely different for prostate surgery than with esophageal or colorectal surgery for example. The outcome is different. In our case, for instance with regards to colorectal cancer, our big hope is that we are able to better protect the nerves for sexual and bladder function and radically remove the tumor. This is a somewhat different objective than with esophageal surgery, for instance, where you would prefer to prevent complications with the lungs. This is a complex subject and needs to be answered individually for each type of disease you are treating. Even though the hospital stay is important, it is not the key parameter.

The interview was conducted by Kilian Spelleken and translated from German by Elena O'Meara.