Doctor Amir SoldChairman of the Israeli Association of Endoscopic Surgery
Advanced technology has long been an integral part of modern life, and innovations have also reached medicine. Today, more surgeries worldwide are performed using robot-assisted surgery and robotic navigation systems. Robot manipulators successfully replace the surgeon's hands — they perform actions more accurately, avoid errors, and fully obey the operator's commands.
The main advantages of robotic surgery include minimal invasiveness (surgeries are performed with endoscopic access — without large incisions), a high level of precision (1-1.5 mm depending on the type of system), the ability to use multiple magnifications for visualizing the intervention area, less blood loss, and a low risk of postoperative complications.
Indications
Indications for robotic interventions can include a variety of diseases. For example, the Da Vinci system is widely used in the global practice for minimally invasive surgeries on the prostate, female reproductive organs, for treating vascular anomalies, during surgeries on the stomach and pancreas, spleen, and for the removal of benign and malignant tumors. The robotic system Spine Assist is used for endoscopic vertebroplasty, correction of spinal deformities, treatment of intervertebral hernias, etc. Robotic systems can be used for treating both adult patients and children.
Contraindications
Contraindications are determined by the specific type of intervention, but generally, the most common include severe obesity, skin diseases, abnormal cardiovascular conditions, and certain acute and chronic diseases in an exacerbation stage (phlebothrombosis, gastric ulcer, anemia, etc.).
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Preparation
Preparation for the intervention aims to minimize the risk of possible complications and includes several stages common to any surgical operations, including robotic ones. For specific types of interventions, this list may change or be supplemented.
- A mandatory condition is preliminary diagnostics with the examination of all parameters that are critical for the effectiveness and safety of the operation — blood and urine tests, assessment of the cardiovascular system, identification of possible infections, determination of comorbidities, identification of drug allergies, etc. If there are deviations from the norm, appropriate therapeutic measures are taken.
- Several days before hospitalization, it is recommended to switch to a more gentle diet, consuming at least one and a half liters of fluids per day.
- As per the physician's indications, several days before hospitalization, the intake of certain medications (aspirin, warfarin, NSAIDs, etc.) may be discontinued.
- One day before the intervention, it is recommended to switch to liquid food and exclude solid foods from the diet.
- On the eve of the operation, the patient ensures hygienic preparation.
- For elderly patients and those showing anxiety, sedation with calming agents may be administered before the intervention.
Types of Procedures
Robot-assisted surgeries in Israel are performed using the latest high-tech systems. The Ichilov (Sourasky) clinic has several such systems, including the Da Vinci surgical robot and the Spine Assist robotic navigation system.
The Da Vinci system consists of several modules, including a control module where the surgeon sits and observes the progress of the intervention, and an operational module — four manipulators with surgical instruments. This robot is widely used for various surgeries, from tumor removal in the gastrointestinal tract to treating kidney diseases and reconstructing heart valves.
The Spine Assist system is used in spinal surgery and represents a robotic navigation system. It is designed to allow the surgeon to navigate using a three-dimensional model of the spine constructed from several X-ray images — this approach ensures intervention accuracy at the level of one and a half millimeters and reduces the radiation exposure during preoperative CT scans by up to 50%.
Joint Replacement
The new generation of computer navigation surgical systems equipped in the clinic enhances the precision of actions during surgeries and improves patients' subjective satisfaction with their outcomes.
Minimally Invasive Total Hip Replacement (Total Hip Replacement) – a new opportunity provided by modern technology. All components of the joint are replaced with artificial implants that last for many years.
Total Knee Replacement (Total Knee Replacement) – another type of joint replacement that restores freedom of movement in the knee and replaces damaged parts of the joint with implants made of artificial materials.
Spinal Surgery
The Spine Assist navigation system is widely used for treating deformities and degenerative changes in the spine, enabling several types of minimally invasive procedures.
Discectomy in Israel (Discectomy) – removal of an intervertebral disc for treating hernias.
Laminectomy in Israel (Laminectomy) – decompression of nerve roots and the spinal cord through minimally invasive excision of the vertebral arch.
Spinal Fusion in Israel (Spinal Fusion) – fixation of adjacent vertebrae using metal implants. This procedure is widely practiced for spinal anomalies such as scoliosis (Scoliosis).
Neck Tumors
Robot-assisted surgery is actively used for treating various neoplasms, including when removal of neck tumors in Israel (Neck Dissection) is required.
Partial Thyroidectomy in Israel (Partial Thyroidectomy) – resection of one lobe of the thyroid gland or a larger part of both lobes.
Total Thyroidectomy in Israel (Total Thyroidectomy) – complete removal of the gland.
Gynecology and Oncogynecology
The Da Vinci system is widely used in gynecology. Its application allows for gentle surgeries and enhances diagnostic accuracy.
Diagnostic Hysteroscopy in Israel (Diagnostic Hysteroscopy) – a procedure performed to examine the endometrium for polyps, to investigate causes of uterine bleeding, etc.
Operative Hysteroscopy in Israel (Operative Hysteroscopy) is performed for the removal of polyps and fibroids, uterine adhesions.
Bilateral Laparoscopic Cystectomy in Israel/Unilateral Laparoscopic Cystectomy in Israel (Bilateral/One Side Laparoscopic Cystectomy) – minimally invasive resection of benign neoplasms of the ovaries.
Total Abdominal Hysterectomy in Israel (Total Abdominal Hysterectomy) – resection of the uterus with laparotomy access through an abdominal wall incision. This intervention is performed for treating malignant lesions of the uterus.
Bilateral Oophorectomy in Israel (Bilateral Oophorectomy) – resection of the ovaries in cases of malignant and benign tumors. This procedure is also used as a preventive measure alongside the treatment of uterine cancer.
Radical Hysterectomy, Omentectomy, and Lymph Node Dissection in Israel (Radical Hysterectomy, Omentectomy, Lymph Node Dissection) – an extensive complex intervention performed for treating late-stage uterine or ovarian cancer, including additional excision and resection of lymph nodes located in the pelvic area.
Mammology
Methods of robotic surgery are often in demand for treating malignant neoplasms of the breast.
Lumpectomy, ALND in Israel (Lumpectomy, ALND) – a gentle procedure for removing part of the breast and dissecting axillary lymph nodes.
Mastectomy in Israel (Mastectomy) is performed for treating malignant breast tumors in late stages and involves resection of a large volume of affected tissues.
Gastroenterology
Clinic specialists have extensive experience in using robotic surgeries for treating gastrointestinal diseases, particularly performing resections of bowel segments, fundoplication, and gastric bypass, as well as gallbladder resections, etc.
Laparoscopic Cholecystectomy in Israel (Laparoscopic Cholecystectomy) – a minimally invasive procedure used for treating cholecystitis, cancer, and some other pathologies of the gallbladder. The robotic surgery without an open incision (the robotic surgeon's instruments are introduced through four small punctures in the abdominal wall) reduces the risk of complications and accelerates postoperative recovery time for the patient.
Prices for Robotic Procedures
The equipment intended for robotic surgeries is very expensive. Only large medical centers (such as Ichilov (Sourasky)) can afford to purchase such costly equipment. Thanks to the active involvement of the government in this matter, Israeli clinics manage to keep the cost of robotic surgeries below the global average (for example, they are cheaper than in the UK or the USA, Belgium or Canada, by at least 30%).
- Degeneration of the Intervertebral Disc
- Tonsil Cancer
- Spinal Canal Stenosis
- Trabecular Adenoma
- Deep Vein Thrombosis
- Cholecystitis
Advantages of Robotic Surgery in Israel
- Robotic surgeons and state-of-the-art robotic navigation systems from leading global manufacturers. Israel is one of the centers for the development of global medical robotics.
- Specialists with extensive experience in performing minimally invasive robot-assisted interventions. Preparing such a specialist requires years of training and clinical practice. Robotic surgery has its own peculiarities, and Israeli surgeons are well-versed in this field.
- Thorough patient examination before surgery is the key to successful treatment and the absence of complications. In Israeli clinics, diagnostics are conducted promptly and using equipment that is at least as high-tech as the robotic surgeons.
- An individual approach is applied to each patient, with doctors considering the patient's condition and wishes, and a dedicated curator-translator monitors the course of treatment procedures for each clinic guest.