An hour before the operation began, another doctor called Dr. Ren Shancheng and said it was [the patient said that he wanted to say two more words to you before anesthesia]. I can feel that the patient is still worried.
This operation is said to be special and special, said not special and not special.
This is especially because, in addition to Ren Shancheng, deputy chief urologist of Shanghai Changhai Hospital, who is in charge of the operation, there is also a [not human] guy-Leonardo da Vinci’s surgical robot.
It is not especially because Leonardo da Vinci is used in two or three surgeries every day in the hospital. For Dr. Ren, he himself is already very skilled in this and has obtained the qualification of robot surgery four years ago.
How did Leonardo do the operation?
Because he is used to working with Leonardo da Vinci, Dr. Ren easily introduced the role of each part while changing his surgical clothes.
The full name of Leonardo da Vinci’s surgical robot is [Leonardo da Vinci Robot Assisted Surgery System]. It does not look like a [human], but consists of a surgeon’s console, four mechanical arm systems and a high-definition imaging system.
Leonardo da Vinci’s four mechanical arms are like spider’s feet, which can rotate and bend. The [wrist] can not only bend 90 degrees downward, but also rotate 540 degrees freely, which is more flexible than human wrist. One mechanical arm is equipped with a camera to [broadcast live] the patient’s internal conditions on multiple screens in the operating room. The other three mechanical arms can be equipped with different tools such as scissors, needle holders, surgical forceps, etc. according to the needs of the operation.
The operation began. Dr. Ren cut six minimally invasive holes about 1cm in the patient’s stomach, one hole for a camera, and three holes for three mechanical arms for operation. The last two holes allowed two assistants beside the patient to assist Dr. Ren in some auxiliary operations.
During the operation, Dr. Ren sat on the console nearby, observing through high-definition 3D camera while controlling the other three mechanical arms.
The assistant is next to the patient and provides some assistance to Dr. Ren through the other two holes.
Leonardo da Vinci has what advantages in surgery?
Leonardo da Vinci can participate in almost all surgical departments, but according to US statistics, 20% are urological surgery, 52% are gynecological surgery, and 24% are general surgery [1].
[Leonardo was not specially designed for urology, The reason why urology is used more frequently is that Because it is very suitable for working in a narrow space. Urology has many operations. For example, radical prostatectomy can also be done by traditional laparoscopy, but the doctor’s technical requirements are higher. After using Leonardo da Vinci skillfully, the doctor will move faster, the operation time will be shortened, the probability of complications such as urinary incontinence after operation will be reduced, and at the same time, the doctor can protect the nerve more accurately.] Ren said.
At present, in their hospital, about 70% of radical prostatectomy, 50% of radical bladder cancer and 50% of partial nephrectomy are completed with Leonardo da Vinci.
Laparoscopic surgery is like a doctor holding chopsticks to operate in a patient’s body, keeping a posture for a long time, and often suffering from waist soreness and backache when getting off the operating table. With Leonardo da Vinci’s operation, doctors can observe the patient’s body condition in real time through the console, and can enlarge it by 10-15 times. The 3D image in front of them is like actually getting into the patient’s stomach.
[Because the trauma is small and the operation is accurate, the vast majority of patients do not need blood transfusion when Leonardo da Vinci is used for the operation, which can better protect the surrounding organs and shorten the hospitalization time.]
At the same time of introduction, Dr. Ren also completed the robot radical prostatectomy in more than an hour.
Of course, Leonardo da Vinci is not omnipotent either.
A study in the authoritative medical journal JAMA mentioned that when performing total hysterectomy, the probability of complications between robot-assisted surgery and laparoscopic surgery is almost the same, but the average cost is nearly 2,200 US dollars more [2].
The American Society of Obstetrics and Gynecology (ACOG) also issued a statement saying that [robotic surgery is not the only minimally invasive surgery for total hysterectomy, nor can it be said to be the best or the most economical] [3]. This at least shows that robots have no obvious advantages in total hysterectomy.
Doctor Ren also said: [At present, robots cannot complete all surgical operations. In addition, robots only show obvious advantages in some operations. Some operations, if it is easier to do with laparoscopy, can choose laparoscopy; It is determined that the use of robots can bring benefits to patients, and the economic situation and personal wishes of patients should also be considered. All these should be well communicated in advance.]
If it is an operation, there is a risk.
In FDA’s medical device database, hundreds of adverse event reports of Leonardo da Vinci robots are received every year. The vast majority of these reports are actually due to improper human operation, but a few are due to machine failures, resulting in injuries or deaths of patients.
However, robot-assisted surgery is still relatively safe, because machines are generally more stable than people. Perhaps it is because doctors with robot surgery qualifications in China already have rich surgical experience, and no serious accidents of surgical robots have been reported in China.
However, Dr. Ren also said that when he first came into contact with Leonardo da Vinci, he was also worried about [something].
He recalled: [The first operation was also the simplest one. It was difficult to convince the patient at that time. Although it has been widely used in the United States, it is still rare in China. At first, patients thought it was what’s “new weapon” and took him for testing. However, in recent years, more patients have begun to pay attention to robotic surgery, and even some patients from other places have specially gone to the outpatient department to name and perform robotic surgery.]
Robot surgery has just started in China.
There are more than 5,600 hospitals [4] in the United States, and a total of more than 2,000 Leonardo da Vinci surgical robots [1] have been installed. It can be said that almost all hospitals of a slightly larger scale have one.
Although the first Leonardo da Vinci was introduced to the 301 Hospital of the People’s Liberation Army in 2006, the development in China has been relatively slow for a long time.
First, the price is high: the hospital needs more than 20 million RMB to purchase a Leonardo da Vinci, and the depreciation cost of the machine is also relatively high. The cost of robotic surgery for patients is about 30,000 more than that of laparoscopy, and medical insurance is not reimbursed.
Second, the threshold is high: doctors must first have rich surgical experience, and then go to designated hospitals in Hong Kong for training to obtain the qualification for robotic surgery; Every Leonardo da Vinci entering China has to go through the approval of the Ministry of Health.
Because it is not sure how much robotic surgery can benefit patients, the government’s attitude was relatively conservative before, and almost only 3A hospitals are qualified to introduce surgical robots. After several years of exploration, the policy may be slowly liberalized. By the end of 2015, there were 42 Da Vinci units in China, and more than 10 units were installed each year in 2014 and 2015 [5].
As of October 2015, a total of 20,477 Leonardo da Vinci surgeries had been completed in China over the years [5]; According to public information from Leonardo da Vinci’s manufacturer, Intuitive Surgical, there were nearly 570,000 Leonardo da Vinci surgeries worldwide in 2014 alone, of which about 79% were performed in the United States [1].
FDA continues to monitor Leonardo da Vinci’s use. The application of robotic surgery in China has just started. It is hoped that there will be a more perfect safety supervision system in China so that it can better benefit patients and doctors.