When does it make sense to use the daVinci surgical system?
Bolenz: The daVinci surgical system offers great benefits, especially when it comes to surgeries in the pelvic area. In fact, it has been adopted as the standard approach for this type of intervention. The surgical system is especially useful in operating fields that are located in deep and very tight cavities, including the removal of rectal cancer or prostate cancer and where subsequent reconstruction is needed. The reconstructive component in this type of surgery is a key criterion for using the daVinci surgical system. Sutures in deep cavities require the surgeon to have enough room to navigate the suture needle. This surgical method has very quickly established itself as the best radical prostatectomy technique (removal of the prostate gland).
How do surgeons learn to perform robotic surgery?
Bolenz: There are structured training concepts that are increasingly being standardized by the professional societies. The concepts usually imply that surgeons already have some open surgery experience before they are introduced to the method using various models and simulators.
Intuitive Inc. is the maker of the daVinci surgical system and offers a structured, partly online training program. It ranges from various theoretical continuing development programs to simulation training. The selection includes surgeries using pigs and surgeries on humans, which are always supervised by an expert.
The German Society for Robot-Assisted Urology is presently building a curriculum that allows respective certification, demonstrating successful completion of the structured training program. It must be emphasized that the surgical robot cannot operate autonomously without the control of a surgeon. This robotic-assisted system is a high-precision tool that is only as good as the surgeon and can thus only achieve what the surgeon is capable of accomplishing.
What are the risks of robotic-assisted surgeries?
Bolenz: I don't see any actual higher or increased risks compared to open surgery. There are some contraindications - such as someone suffering from cardiac insufficiency, chronic lung disease or patients who had major previous surgeries in the operative field slated for keyhole surgery- that might argue against the use of robotic-assisted intervention. It is more a question of how comprehensively you want to apply and can afford to use this method. I think there is a greater risk if the system is broadly used for all surgical procedures, even though it might not be particularly beneficial or helpful in certain interventions. Minimally invasive robotic-assisted surgery should only be an option for those patients and types of surgeries where this procedure makes practical sense and offers true advantages.