10 Years of Robotic Surgery in Mostiště

May 01^st, 2017, is a special day for St. Zdislava Hospital in Mostiště: It marks the tenth anniversary of the robotic system DaVinci. When installation of the surgical robot was started in 2007, it was an ambitious project. All over Europe, there were only five private facilities with this technology – and Mostiště then became the sixth. Senior physician Dr. Jaroslav Tvarůžek recalls: “The goal was to further expand the minimally invasive laparoscopic procedures and make them more effective.”

Today, Mostiště is among the top European centres that offer specialised procedures using robotic surgery for their patients. A whole host of procedures, including radical resection of the prostate, are carried out using minimally invasive techniques.

Dr. Tvarůžek: “The concept of this workplace was clear from the beginning. We focused on the surgery of prostate cancer. Secondly, we included surgery for malignant tumours of the rectum into the program, then for tumours of the kidney, of the stomach, and from urology.”

Briefly: The robotic surgery in Mostiště is oncological surgery. Its goal is to efficiently remove tumours with as little stress for the patients as possible. “The surgical heads of the robotic instruments are very small – only 8 mm –, and they have an operational joint that allows precision of movement in the operating area to be increased”, as the senior physician explains.

The concept underlying robotic surgery is straightforward: The more accurately an operation is performed, and the less surrounding tissue is affected, the better it is for the patient. The surgical robot controlled by the surgeon helps to achieve such a result. The robot thus does not perform surgery independently.

Surgeries performed using robots are minimally invasive and therefore gentle. In general, patients lose blood neither during the procedure nor in the period afterwards. They have small scars (about 5 scars with a size of about 1 cm), which usually heal very quickly and without complications. The occurrence of pain is also reduced and incomparably lower than in patients with a surgical scar 30 or more centimetres in length. A gentle surgical procedure also shortens the duration of the entire recovery phase, so the patient returns to everyday life earlier than after classical abdominal surgery or laparoscopy.

This surgical result that takes the patient back to normal life very soon has also fundamentally changed attitudes towards the financial effort of the interventions. For particularly the financial aspect has often been the target of criticism in recent years. Above all, the costs are claimed to be disproportionate, and “normal” laparoscopy much cheaper. In Mostiště this is known indeed. Dr. Tvarůžek is convinced that the success of a robotic treatment program absolutely depends on the interventions for which it is used. As he says, a robot is not suitable for surgical tasks that can be handled by normal laparoscopy, but is to be used specifically where it actually provides benefits for patients and surgeons.

One example is robot-assisted radical prostatectomy, which is a standard procedure in Mostiště. Here, the instruments can be applied to positions for which a human hand would be too large and therefore cannot be rotated. Or where conventional laparoscopic instruments cannot be adjusted to the required inclination to the tissue to be operated on so as to make the procedure safe.

More than 350 of such prostate operations for malignant carcinomata are planned in 2017. The patients for this come from all over Europe: Spain, Germany, Russia, Ukraine, Austria and many other countries. This is something to be rightfully proud of in Mostiště. And the director of the robotic surgery centre holds something else dear as well: “The team of the robotic workplace has remained virtually unchanged over the entire decade. Today, this is to be considered as an absolute exception in healthcare and improves quality, of course.”

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