Operate and teach robotic surgery

In July this year, the first surgery assisted by the da Vinci robot was performed at the University Center for Robotic Surgery (UCCR) in Wroclaw. To date, 52 prostatectomy procedures have been performed at the center. Now it's time for intensive training of specialists.

- In the UCCR, in addition to treating patients, we will develop education and science," announced Wroclaw University of Medical Sciences rector Prof. Piotr Ponikowski during the official opening of the center on September 20 this year, congratulating Dr. Bartosz Malkiewicz on closing the next stage of this project. The ceremony was attended, among others, by Deputy Minister of Education and Science Wojciech Murdzek, Lower Silesian Governor Jarosław Obremski, representatives of the Lower Silesian Voivodeship Board Marcin Krzyżanowski and Krzysztof Maj. The symbolic cutting of the ribbon was not to be missed - this time it was done with surgical-robotic precision by Dr. Bartosz Malkiewicz, coordinator of the Wroclaw Medical University for UCCR, using the da Vinci robot.

Deputy Minister of Education and Science Wojciech Murdzek stressed that we are witnessing a moment of significance in the development of the university and hospital, but not only. Today, modern technologies support human knowledge and abilities, and the ability to use them should be a standard in the education of future doctors: - I wish you that your plans and dreams are always at a high level. I also know that the bar is set high here by Professor Ponikowski," he added.

Robotic surgery is growing rapidly in Poland. To keep up this trend, it is not enough to have a robot - specialists who can perform the procedure with it are needed. At the UCCR in Wroclaw, doctors are already training in this surgical technique, gaining experience. There are plans to move further in this direction, making the most of the center's potential.

- From the beginning, the assumption was that the UCCR's activities would not be limited to the clinical area, but that it would become an interdisciplinary research and teaching center, unique in the country, explains Bartosz Malkiewicz, MD. - We started with surgery for radical removal of the prostate, because until recently it was the only robotic procedure in Poland reimbursed by the National Health Fund. At the same time, we conducted training of operator urologists and assisting doctors, anesthesiologists and nurses. Now they will be joined by operators from other specialties, including oncologic surgeons and gynecologists. This is a necessity in order to adjust the pool of qualified medical staff to accommodate the growing number of reimbursable robotic procedures.

A robot is just a tool

The dynamic development of robotic surgery in Poland followed the introduction of reimbursement by the National Health Fund for prostatectomy procedures for patients with prostate cancer last April. In August this year, two more robotic procedures were included in the basket of guaranteed benefits: for the treatment of endometrial cancer and colon cancer.   

- Currently, surgical robots are at work in about 40 hospitals in Poland, but this is changing rapidly, as these systems are being installed in more centers month by month, week by week, says Professor Tomasz Szydełko, head of the UMW University Center for Urology and national consultant in urology. - Such rapid development of domestic robotics poses some challenges. The so-called surgical robot is not really a robot, but only a surgical tool. After all, it lacks autonomous intelligence and the ability to operate independently. There is no robotic surgery without a well-trained surgeon.

According to Prof. Tomasz Szydełka, all surgical specialties should have robotics in their training program. This has already been done in urology, where mandatory internships in robotic surgery centers have been introduced in the specialty program, effective from this year. In which centers should such internships take place?

- In my opinion, university centers that have both experience in didactics and robotic surgery are ideally suited for this, the national consultant in urology believes. - Thanks to this, they are able to plan the training in such a way that the surgeon, after just a few courses, will be able to perform procedures independently. This kind of training should be given not only to operating doctors, but also to assistants, anesthesiologists and nurses. After all, robotic surgery involves a whole team of people who not only need to be educated, but who also need to be provided with access to information. The University Clinical Hospital and Medical University of Wroclaw is a center that can provide this kind of training at a very high level.

Providing specialized training to the highest standards at UCCR is ensured by experienced medical and teaching staff with top-of-the-line equipment. In addition to the da Vinci Xi robot itself, UCCR's robotic room is equipped with a state-of-the-art multimedia system, which allows for live streaming of operations in progress and two-way contact between the operating team and the students.

Financial support needed

In the long term, it is also planned to make the UCCR available for teaching medical students to learn the latest therapeutic methods during their clinical training period. Adapting the unit for teaching purposes (including a second operator's console with simulator, phantoms for robotic surgery) requires additional funds, for which the UCCR will apply, among others, under the FERS competition , in cooperation with the UMW Project Management Center.

- We are planning theoretical and practical training at various levels of medical staff training, including international training with experts in robotic surgery," adds Dr. Bartosz Malkiewicz. - One of our goals in this area, for example, is to create and implement training programs in urogenital cancer therapy. In scientific activities, we are oriented, among other things, to conduct innovative research and development directions using robotic technology and, for example, augmented reality techniques, with the aim of expanding the potential of using the robotic surgery system. Through participation in the international ROSE project, to which robotic surgery centers from 10 European countries have been invited in addition to UCCR, we will also have the opportunity for interdisciplinary analysis of clinical effectiveness, training and new developments in the field of robotic surgery. We plan to create high-quality prospective clinical databases. This is the basis for research projects and allowing us to participate in international projects. On the clinical side, given the experience of our operators, we should be a reference center for robotic surgery, and we will strive for this by intensifying clinical work in the first period of UCCR's operation.

Photo: Tomasz Król/USK