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Robotic operations in thoracic surgery


Professor Dr. Bernward Passlick – Medical Director of the Depatment of Thoracic Surgery of the Medical Center – University of Freiburg describes his experience with the Da Vinci Robot in lung surgery.

What does the robot look like?  Basically, you can imagine two parts. One is the robot itself, which cannot do anything by itself, but is only remote-controlled. The robot hovers over the patient, so to speak, and the robot arms are brought up to the patient just like in a minimally invasive operation. That's one part. The other part is the so-called console, where the surgeon sits. This consists of a monitor and two handles. With these handles, the surgeon can control the operating arms and the optics as well as all the technique. These are basically the two parts that are important.

In thoracic surgery as well as in other disciplines, the main advantage of the robot is that it can make extremely fine movements in a small space. This distinguishes it from other minimally invasive procedures in the sense that the mobility of the operating arms is so good that we can also operate in the smallest areas. The most common operations in thoracic surgery are based on this.

On the one hand, there is tissue behind the breastbone, where the space is very, very narrow and you have to dissect very finely on the large vessels. On the other hand, there is the diaphragm, i.e. very basal, where it enters the abdomen and where you have to control the tissue very carefully in order to handle it.

The essential thing about thoracic surgery and the robot compared to other disciplines is that we always operate alongside or on the heart. That means that we constantly have movement in the chest that needs to be balanced out and that might make things a little more tedious.

The robotic operations in thoracic surgery are not very widespread throughout Germany yet because the system is not yet available at all clinics. In this respect, we are happy that we can advance the technology here in Freiburg.

The planning of surgeries is basically the same as with other minimally invasive interventions, with the exception that we have to access the chest between the ribs. This means that we don't have a lot of options to choose from but have to think carefully in advance which point in the chest we want to get to, and we also have to put the appropriate access points through the ribs so that we can get there in the targeted manner. A change during the operation is not cheap on the one hand and very time-consuming on the other.

We expect to work much more precisely by using this technology. It is already evident in the first few months since we have been using the robot.