Medical secret

Surgeons do not know who should pay for the technical inspection of a unique robot

The technical re-equipment of medicine, systematically carried out by the state within the framework of the priority national project “Health” over the past few years, is gradually beginning to produce tangible results. The most complex and expensive equipment, most of which were delivered last year, has already been installed for the most part, has been tested, mastered by doctors and is finally ready for widespread use.

As Vremya Novostei learned, this year several large federal clinics began performing operations using robotic surgeons - unique remote-controlled digital endoscopic devices. After such an intervention, only three punctures remain on the patient’s body, which naturally shortens the rehabilitation process. This method has been widely used in the most diverse surgical centers in the United States and European countries over the past ten years, but due to its high cost (a basic robot costs several million dollars) it has never been available to domestic doctors and patients. But only robotic medicine makes it possible to perform a whole range of complex operations on the heart, liver, kidneys, lungs, prostate, bladder - operations so delicate in execution that it is extremely difficult to talk about the possibility of repeating them with the “bare hands” of a surgeon. Even the most trained human hands are too bulky and rough tools. The robot, for example, makes it possible to expertly remove tumors in the most difficult-to-reach places in the abdominal organs and perform bypass surgery of heart vessels without cutting the chest.

The robot's manipulators are movable in seven planes, which significantly exceeds the capabilities of the hands of human limbs; they never tremble and can freeze in place for an arbitrarily long time. In addition, the da Vinci robots purchased by the Ministry of Health and Social Development, the only manufacturer of which is the American corporation Intuitive surgical, have as many as four “arms”: two correspond to the surgeon’s hands, one is a movable tripod for a video camera with backlight, transmitting a three-dimensional image to the surgeon’s console, and one more can be used to install additional tools. Manipulations are carried out through special ports installed on the patient’s body through small incisions (1-2 cm).

The surgeon's console may even be located outside the operating room. On the screen, the surgeon—the robot operator—sees a color three-dimensional picture of the internal “space” of his patient and the area of ​​direct surgical intervention. Rings of sensitive joysticks are placed on his fingers, transmitting movements through a fiber-optic cable to the robot's manipulators. The main trick is that during the intervention the surgeon can make quite sweeping movements, and the computer transmits them “to scale”, reducing them by two, three or five times. This reduces the risk of accidental damage to healthy tissue to a minimum.

“We have been operating on our patients with the help of a robot since March and have managed to perform seven operations,” the head of the department of new technologies at the A.V. Institute of Surgery told Vremya Novostey. Vishnevsky professor Andrey Fedorov. According to him, the prospects for using this unique technique are very broad: it can be used to perform up to 95% of various heart surgeries and 85% of various types of urological interventions. “Western medical statistics indicate that with the introduction of robotic surgeons into practice, for example, the total number of prostate operations has increased significantly. That is, they began to operate on those cases that were previously considered difficult to perform,” notes Mr. Fedorov. A team of surgeons and operating room nurses (which is no less important) from the Vishnevsky Institute has completed training on working with new technology at the International Institute of Robotic Surgery in Strasbourg and is ready to perform from 50 to 100 operations per year.

The technology will not let you down, doctors with new, unique qualifications for our country say unanimously. But the main thing is that the state does not let us down. A big concern for doctors who have spent many months training with the robot is the need to pay for the maintenance of a complex device and buy consumables. All this costs 200-250 thousand euros per year. Moreover, it is simply impossible to save money here: each replaceable robot tool is equipped with a chip that counts the number of operations and does not allow it to be used more than the number of times established by the rules. Based on this calculation, the technical costs of performing one operation with a robot can reach 5 thousand euros, not counting the payment of the doctor and junior medical staff. “The Ministry of Health and Social Development understands the extreme importance of the development of high medical technologies and, despite the current economic situation in the country, is still ready to support our work,” the clinic’s managers are confident. According to them, the parent department promised to maintain the required level of funding in 2010, although prices for consumables have increased significantly due to the rise in foreign exchange rates against the ruble.

Galina PAPERNAYA