Does robotic surgery have a future?

Medical technology Super microsurgery - in the future with surgical robots?

Da Vinci is at work: the robot hangs over the patient like a giant octopus. Various surgical tools are attached to the arms. They drive around in the patient's open body. That sounds martial. And that looks a little strange too. But don't worry: everything is under control. At the other end of the room is the head of urology at the Leipzig University Hospital, Jens-Uwe Stolzenburg. He operates the robot via a console. "Ultimately, I operate everything myself. That is also the important thing. This is not robotic surgery. This is robot-assisted surgery. You shouldn't confuse that. This is fundamentally different because the robot does not make any movement itself."

Da Vinci also operates in Leipzig

Da Vinci is now used in around 100 clinics in Germany. After all, it has advantages, also here in Leipzig. Without Da Vinci, the operation would be difficult, says Prof. Stolzenburg. The patient is very stout. "You would hardly be able to operate on open surgery because you cannot get into the depths. It is very confusing. Here I am directly on site. The camera, enlarged ten times, shows me everything. I can perform the finest movements."

Not suitable for microsurgery

However, the robot cannot be used everywhere. For example next door: Preparations for a microsurgical operation are currently underway. Very small vessels in the millimeter range should be connected to one another. It is frigid and small. The Da Vinci robot cannot help here. Plastic surgeon Tom van Mulken from the Netherlands explains why: "The instruments in these robots are far too large for microsurgery. That is the first problem. The second problem is: The Da Vinci robot and other similar types of robots use cameras. They are It's pretty good, but for real microsurgery, where everything is very small, these cameras are useless. We surgeons then use powerful microscopes that magnify everything by 20-30-40 times. "

MUSA should fix it

So it was clear to Tom van Mulken: A new robot was needed. One that works for microsurgery. Together with the Dutch company Microsure, he developed the MUSA system, which has now been tested in practice for the first time. "The robot does two things: First, it filters out the surgeon's tremor. The tremor is the natural tremor of the hand. We all have that. The second thing the robot does, it scales the movement. That means: I can do the robot say that if I move four inches, it only moves an inch. It then copies my movement, but makes it smaller. " The tests had shown that the robot works and can be used. But he had not done better than the experienced surgeon.

So far only people at work

Back to the operating room in Leipzig: This is where the new robot will eventually be at some point, if Tom van Mulken has his way. There are still only people at work here. One of these people is Professor Stefan Langer, a specialist in plastic, aesthetic and special hand surgery at the Leipzig University Hospital. Today he wants to transplant lymph nodes from his stomach into his leg. Particularly small parts: in order for the transplant to work in the leg and remove the lymph, it has to be connected. To do this, he sews small blood vessels together. "That's one millimeter, look here: one, two. That's one to two millimeters. When it is flattened, it's three, when it's inflated it's two and a half. But that's good, you have to say. It's good do. That is, as the saying goes, our daily work. "

"Why should a robot do that?"

With the help of his assistant doctor, he sews the small tubes together under a microscope with a needle and thread. MUSA could assist here. Stefan Langer doesn't think that's necessary: ​​"That's the nicest thing about the operation for us too. Then the transplant is alive, then there is a pulse in it. That is the best experience of the day. [...] In any case, it does us Yes, well. We practically created this transplant, down there where it belongs. Why should a computer take over or a robot? I want to take over. I want to see that this is my project. And that's why comes here no robot in. "

"Not for day-to-day operations at first"

The sewing together is not only the most beautiful job, it also only makes up a fraction of the procedure. Only after an hour and a half is it even that far. Before that, Langer and his team have to prepare the leg. This means; Make space for the new lymph nodes and expose and select the vessels. Real innovation would be if a robot could take over this at some point, says Langer: "That means we need systems that can react, that also recognize whether the transplant is alive and is also supplied with blood. Those are the next steps. I want these First rate new technology positively, but we don't need it for our day-to-day operations at first. "

MUSA developer thinks ahead

For the new MUSA robot system, maker Tom van Mulken is also envisioning interventions that are not yet part of the operating theater today. Reattaching fingertips, for example, but also much more forward-looking: "When we talk about the future: There is the idea of ​​growing body tissue outside of the body. Perhaps in the future it will be possible to grow body parts, such as an ear Then you need very specific instruments to connect the body part to your body. This kind of robot could help with that. "

Maybe MUSA will make it to the Leipzig University Hospital under these circumstances. Whether MUSA or not, all surgeons agree on one thing: as far as robots in the operating room are concerned, we are only at the beginning.