Present in many operating theaters, will the robot-assistant become essential? Surgeons favor it for the safety of the gesture, the patients ask for it for less invasive gestures. Report on orthopedic surgery at the Médipôle Garonne clinic in Toulouse.
That morning, in one of the operating theaters at the Médipôle Garonne clinic in Toulouse, he was the first to be installed. He is the Mako / Stryker robot, a 400 kg rolling cart equipped with a robotic arm and a camera connected to a computer. He will assist the surgeon with the placement of a knee prosthesis on an 88-year-old patient. After their counterparts in Montpellier and Nîmes, orthopedic surgeons from Médipôle Garonne are the first in Western Occitania to use this equipment for fitting knee and hip prostheses.
The intervention was prepared upstream: a scanner modeled the patient’s knee in 3D in order to optimize the choice of prosthesis and its positioning. Near the operating table, an engineer specializing in Mako, attached to the manufacturer Stryker, will ensure the proper functioning of the equipment. “We arrive at the OR with peace of mind. Everything has been framed ”, underlines Dr Jean-Michel Lafosse, orthopedic surgeon at Médipôle Garonne.
The patient understood this too. As soon as he enters the OR, he asks if the robot is there. This will only come into action 30 minutes after the incision, time to remove the menisci and cruciate ligaments, to place a sensor in the tibia and another in the femur. The scientific robot has received the indications, the surgeon will not be able to cut the bone beyond the green zone displayed on the screen. “This semi-automation inspired by the automotive industry offers precision of the order of a millimeter, the safety zone is established so as not to touch the nerves and ligaments located outside. This is not a revolution but a natural evolution of our practices to further reduce the points mentioned and the pains and interact with the patient’s anatomy ”, explains Dr. Grégoire Laumond. “The robot is an augmented human that we activate. We believe that this is the future, ”adds Dr Jean-Michel Lafosse.
“It extends our tools and our gaze”
Other surgical specialties have for several years improved their procedures with robotic assistance. This is the case in oncology for the ablation of urological, gynecological or ENT tumors.
“In ENT, the robot has enabled us, in some patients, to avoid a tracheotomy going through the mouth. The postoperative follow-up is much simpler for those who can benefit and the growing expertise of the teams makes it possible to operate on complicated pathologies. The robot is not used routinely but it is integrated into our thinking and our decision trees. It is an extension of our tools and our gaze that facilitates movement, ”testifies Prof. Sébastien Vergez, ENT surgeon at Toulouse University Hospital, who has been working with the Da Vinci robot since 2008.
“We are in the prehistory of surgical robotics”
“Robotic platforms, under the guise of training, more efficient surgery, safer for the patient and more comfortable for the surgeon. When the cost issue is resolved, all blocks will be equipped with it. Robotic assistance is only used at 2% today. We are in the prehistory of surgical robotics and a whole generation of surgeons can no longer conceive of working without it. The learning curve is shorter, the average level of results rises, ”summarizes Dr Nicolas Doumerc, urological surgeon at Toulouse University Hospital.