Robots for less invasive surgery

The patient is there, lying down and asleep awaiting the removal of a uterine fibroid. Around her, the team from the gynecological and oncological surgery department of the Saint-Étienne University Hospital is working to start up and equip a Da Vinci surgical robot, developed by the American firm Intuitive Surgical. Since 2001 and its installation at the Limoges University Hospital, this robot, which is a benchmark in its market, has continued to be perfected. Thus the model present today in Saint-Étienne allows, for the same operation as 20 years ago, to make only one hole at the level of the navel whereas until now it was necessary, in order to allow the tools and camera to penetrate the abdomen, piercing four.

Before this dazzling democratization of robotics, surgeons proceeded by “laparotomy”, that is to say with an open stomach, leaving a sub-umbilical scar, as women who have given birth by cesarean are familiar with.

« Installed at the robot console, through our screen, we benefit from a three-dimensional vision, as if we had opened a belly »explains the P^r Céline Chauleur, from the gynecological and oncological surgery department of Saint-Étienne University Hospital. « Sitting in this same place, I manipulate a joystick, which articulates surgical instruments whose maneuverability and precision go beyond the capacity of the hand »she continues. Thus the robot, whose arms are equipped with instruments used to coagulate vessels, cut, then make stitches, allows the surgeon to operate while causing as little collateral damage as possible, by going into very deep places and narrow… by perforating the skin with an incision of barely 2.5 cm.

Reduction of postoperative pain

The benefit: reducing postoperative pain and allowing outpatient care, that is to say a hospital stay of less than twelve hours. « There are 25 years, compared to these few hours, it took a short week of hospitalization »details the P^r Céline Chauleur.

Always less invasive, robotics is now being introduced into other specialties such as radiology. A specialty which is no longer limited to the reading and analysis of a scanner or an MRI. For several years, a subspecialty of radiology has existed: interventional radiology. « Our interventions consist of introducing and guiding equipment such as needles and trocars, after having made a very fine incision in the tissues to treat a pathology using imaging. »details the D^r Sylvain Grange, interventional radiologist at Saint-Étienne University Hospital.

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The Montpellier-based company Quantum Surgical is developing one of these robots for interventional radiologists. Named Epione, it notably equips the Gustave Roussy Institute in Villejuif and the Édouard-Herriot center of the Hospices Civils de Lyon. There, it allows these specialists to remove tumors affecting the liver or kidneys percutaneously. A minimally invasive treatment in which one or more needles are inserted through the skin to the tumor to destroy it. Note that with this robot, artificial intelligence guides the radiologists in order to once again achieve as little collateral damage as possible; therefore better care of the cancer patient.

Economically, the cost of purchasing a medical or surgical robot varies, depending on the model and use, from a few hundred thousand euros to several million. To recoup your purchase, you must therefore make use of it, while organizing care accordingly. According to a study by the Asterès firm dated June 2023, « depending on the organization of the service and the lifespan of the robot (ten or twenty years), the break-even point for robot-assisted surgery varies between 43 and 146 operations per year »all procedures combined.