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Application of surgical vinci da robot in some urological diseases at Vinmec International General Hospital

The article was written by MSc Vu Ngoc Thang - Department of General Surgery, Vinmec Times City International Hospital.

Robotic surgery is laparoscopic surgery performed by a robot (Robot) controlled remotely by the surgeon. Unlike traditional laparoscopic surgery, which is performed directly by the surgeon, robotic laparoscopic surgery is performed indirectly by the arms of the robot.

1. Make a problem


Around the world, the introduction of robotic surgery is a new step forward in laparoscopic surgery that has been applied more and more in different specialties, especially surgery of intra-abdominal organs, surgery. Art with narrow operating space requires ingenuity and sophistication.
In Vietnam from December 2017 until now, Vinmec International General Hospital is the first hospital in the North to have used VINCI DA Robot for laparoscopic surgery to treat endocrine diseases. Urology and Gastroenterology.

2. Urological pathology can apply surgical da Vinci robot


Prostate cancer stage T1, T2 - N0M0. Kidney loss of function Partial nephrectomy due to tumor
Thoát vị bẹn
Bệnh thoát vị bẹn có thể áp dụng robot da vinci phẫu thuật

Kidney tumor stage T1N0M0 Adrenal tumor Prolapse pelvic floor Inguinal hernia Bladder diverticulum Bladder diverticulum Partial resection of the bladder due to cancer, diverticulitis... Total cystectomy due to cancer Re-instubation of ureter and bladder in vesicoureteral reflux disease Double kidney and ureter Narrow junction of renal pelvis and ureter Retroperitoneal tumor Pelvic stone, ureteral stone

3. Some diseases have been operated on by robot da vinci at the urology department

Một số hình ảnh minh họa Phẫu thuật Robot
Một số hình ảnh minh họa Phẫu thuật Robot

3.1 Distribution of diseases treated with robotic laparoscopic surgery Prostate cancer Nephrectomy with loss of function Adjunct nephrectomy in pathology Double kidney and ureter Cancer of the upper excretory tract Partial nephrectomy due to tumor Renal tumor resection Adrenal neoplasm adrenal gland Restoration of the pelvic floor Inguinal hernia Retroperitoneal tumor
Cắt thận do ung thư và cắt thượng thận do u.
Cắt thận do ung thư và cắt thượng thận do u

3.2 Operation time (In minutes) Average operating time: 164.18 minutes. In which, the shortest operation time: 65 and the longest: 312 minutes Intraoperative and postoperative complications: none. Length of hospital stay: 3 days on average. In which, some patients only have to stay in the hospital for 1 day after surgery. Pain after surgery: The patient has almost no pain after surgery. Post-operative follow-up: All patients after surgery were stable, the post-operative follow-up time was from 1 to 24 months without any complications after surgery.
Mổ bóc u thận và Mổ cắt toàn bộ tiền liệt tuyến do ung thư
Mổ bóc u thận và mổ cắt toàn bộ tiền liệt tuyến do ung thư

4. Discussion


Since the introduction of laparoscopic surgery using robots, it has significantly improved the limitations that traditional laparoscopic surgery has not overcome, that is: displaying 3D images instead of 2D images, helping surgery The surgeon feels the space of the organs that need to be dissected more clearly.
Improve the limitation of movement of the instrument: if the wrist is rotated to a maximum of 2700, the robot arm can rotate to an angle of 5400. The operating position is easy to cause fatigue for the surgeon and the operating assistant, the vision of The surgeon must depend on the person holding the camera. The advent of robotic laparoscopic surgery has increased the surgeon's ability, reducing the difficulty and complications in laparoscopic surgery (5).
Through the pathologies that have been operated on at the Urology department of Vinmec Times City International Hospital, we find this is a safe and feasible surgical method for most surgeries that laparoscopic is being performed. can act. This result is also consistent with other reports on robotic laparoscopic surgery published in domestic and international literature (1,3,5)
The number of trocars used in surgery, depends on the disease. injury management and surgeon habits. For simple surgeries that just need to graft the robotic arm once, we use 3 camera trocars and 2 instrument arms.
Nội soi Trocar
Trocar được sử dụng phẫu thuật nội soi

In the case of organs requiring major surgery, we place ready-made trocars and connect the arms depending on the stage of surgery, thereby ensuring that the patient does not have to change positions many times.
In cases where the patient has an old surgical history, after placing the assessment camera, we can perform de-adhesion (if any) first to create space for the next trocars and then proceed with the surgery. By robot, therefore, it also reduces the rate of having to switch to traditional laparoscopic surgery or open surgery.
The overall rate of complications during and after surgery is usually low (1,2,3,4), with the rate of conversion to open surgery from 0% to 13%, this rate depends on the qualifications and experience of the surgeon. as well as the complexity of each type of surgery. At the time of our review, we had no surgery with complications.
Preoperative assessment, BMI as well as pre-abdominal exploration, or removal of adhesions before assembling the robotic arm make surgery more convenient and feasible, thereby helping patients reduce costs When you can't do surgery with a robot, you still have to pay for the equipment fee.
The postoperative hospital stay was significantly shorter in the robotic laparoscopic surgery group compared with the open surgery or conventional laparoscopic surgery group in most of the studies (1,3,4). The median hospital stay for this review was only 3.04 days.
Likewise, with laparoscopic robotic surgery there is almost no pain or very little pain, which is quantified by the VAS scale and based on the amount of analgesia compared with laparoscopic and open surgery.
About the results of close follow-up from 1 to 24 months: no patient appeared complications such as damage to nearby organs, bleeding, residual abscess...

5. Conclusion


Laparoscopic surgery using Da Vinci Robot is a safe, effective and feasible surgical method in large surgical centers with modern equipment and a team of experienced surgeons. For surgeries that previously required open surgery, laparoscopic surgery by robot can now be done easily.
>>> Evaluation of initial results of laparoscopic surgery using Da Vinci Robot system at Vinmec International General Hospital

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