Alberto Breda (Verona, 1973) is the head of the Oncological Urology Unit and of the Renal Transplant Surgical Team of the Puigvert Foundation. In addition, he is the president of Erus, the robotic surgery section of the European Society of Urology.
From this Wednesday through October 28, Erus celebrates. ‘Barcelona Robotika’, its 19th congress, which will be attended by more than 800 surgeons. Six Catalan hospitals will broadcast live up to 38 robotic surgeries. Barcelona is the city in Spain with the most machines dedicated to robotic surgery.
What is robotic surgery?
It is a minimally invasive surgery, like an arthroscopy. [un tipo de endoscopia que consiste en la visualización de una articulación] on a knee. The surgeon sits at a console and, through a joystick, directs robotic arms that move through 360-degree movements. [El cirujano] He is next to the patient and moves the instruments with his hands. In fact, more specifically, this type of surgery is called robotic laparoscopic surgery.
Is the precision higher?
It clearly has a precision that human hands do not. Robotic surgery totally eliminates the tremor, there is HD and 3D vision. We see all three dimensions with 5G technology and in high definition. This did not exist in laparoscopy. [otra cirugía mínimamente invasiva para observar el interior del abdomen y la pelvis] And it still doesn’t exist much, although laparoscopy is growing a lot to match robotics. But robotics is still the ultimate expression of minimally invasive.
Does the robot replace the physician?
No. And it’s not exactly a robot, it’s robotic arms. You need a joystick console with a surgeon to move those hands. But we are far from having a robot that automatically reproduces a surgery as doctors do: you need a pilot, a surgeon, behind the technology. Perhaps, in the not too distant future we will have robots capable of operating alone and the surgeon will do the indication to the surgery, but then the robot will do the surgery for the doctor and will do it with much more precision. For the moment, the surgeon is the protagonist of the operating room. I don’t know for how long. But we are facing a great transition.
“Robotic arms have a precision that human hands do not. Tremor is totally eliminated.”
But the doctor will still be needed.
Yes, because to program you need a doctor, not an engineer. But it is likely that, in the future, the surgeon will have less involvement when it comes to laying his hands.
Why is urology the field in which robotic surgery is most widely implemented?
Because it was the first specialty to embrace robotic surgery in the early 2000s. It was in the USA and in France, where robotic surgery for radical prostatectomy began to be authorized. At that time nobody believed in robotics because it was something futuristic; general surgeons did not bet on it. On the other hand, the urologists, who have always been very fine in surgery, began to bet on minimally invasive surgery, laparoscopic surgery. And the normal evolution of laparoscopy is robotics, because it means moving from minimally invasive surgery to minimally invasive but robotized surgery, which increases precision. The Fundació Puigvert also bet on it: in 2005 the Da Vinci robot arrived and we were the first hospital in Spain to incorporate robotic surgery in a department. Now, of the four operating rooms we have, two, 50%, are robotic. Robotic surgery is very expensive and the national health system does not finance it, so a hospital has to invest a lot of money.
Can it be extended to other fields?
It has expanded. Gynecology, general surgery, cardiac surgery, even otolaryngologist, are starting to use robotic surgery. There are gynecological centers that use it routinely. General surgery has also started to use it. Until 2019, robotic surgery was a monopoly of Intuitive, which is the mother of robotic surgery. But in 2019, the 2,500 patents for the Da Vinci robot expired and now there are no longer any companies producing robots. There are currently 10 robots on the market that have already been built and are working. The door is opening not only to urological surgery, but also to new robots.
“Urology was a pioneer. But gynecology, general surgery, cardio-surgery and even otolaryngology are starting to use it.”
It is the future.
It is the present in fact. There is no doubt that robots will enter into the reality of each one of us. Cars for example already drive themselves. Now everything works through chips and new technology; the future is robotics, so surgery cannot be less.
Which patients can benefit?
Those with prostate cancer – undergoing radical prostatectomy -, kidney cancer – requiring partial nephrectomy – or bladder cancer – requiring radical cystectomy. These patients are the ones who benefit most from robotic surgery in urology today.
The ERUS congress will have 38 live surgeries.
In Spain there are only about 40 or 45 robotic platforms – in Italy there are about 150. Madrid, for example, still has no robots in the Social Security. Spain has been starting to robotize its hospitals for a couple of years now, but we are still underrepresented in Europe. However, we are gradually entering the robotics market, hospitals are starting to acquire robotic systems and in Barcelona there are 16 machines. In other words, in Spain a quarter of this technology is in Barcelona. That is why we are calling this congress ‘Barcelona Robotika’, to transform the city of Barcelona into the epicenter of Spanish robotic surgery. The six urological hospitals with the greatest impact on public health -Vall d’Hebron, Bellvitge, Clínic, El Mar, Can Ruti and the Fundació Puigvert- will be together broadcasting surgeries live from their hospitals to the Fira de Montjuïc.