Robots et chirurgie : la télé chirurgie ou chirurgie mini invasive

Annoncer à quelqu’un qu’il a un cancer de la prostate :

Pour comprendre ce qu’est le cancer de la prostate et comment il est diagnostiqué :

COMPRENDRE LE CANCER DE LA PROSTATE (site de la Fédération Nationale des Centres de Lutte contre le Cancer)

Voir le site internet (très complet et actualisé) réalisé par le service d’urologie de l’hôpital Henri-Mondor (Assistance Publique des Hôpitaux de Paris, AP-HP) : http://urologie-chu-mondor.aphp.fr/

Des explications concises et tenant compte des derniers développements de la chirurgie robotique vous seront apportées sur le site de l'Institut Mutualiste Montsouris, département d'urologie: cliquer ici.

"Annoncer à son patient qu’il est atteint d’un cancer reste un défi pour l’urologue", écrit le Docteur Domenico Savatta.

Chirurgien urologue, pionnier en chirurgie robotique, Dr. Domenico Savatta exerce à Newark Beth Israel Medical Center, dans le New Jersey, USA. Il est membre de l’AUA (American Urological Association), de la Société d’Endourologie Internationale, et de la SLS (Society of Laparoendoscopic Surgeons). Son domaine d’expertise est la chirurgie mini invasive : chirurgie robotique et laparoscopique en urologie. Il effectue différentes procédures chirurgicales en urologie, comme les prostatectomies, néphrectomies et pyéloplasties, avec le système de chirurgie assistée par ordinateur da Vinci™. L’urologie reconstructive, le traitement chirurgical du cancer des testicules, le remplacement de la vessie (après cystectomie, correspondant à l’ablation de la vessie) et la dérivation urinaire continente font également partie de son domaine d’expertise.

Dr. Savatta est un leader dans le domaine de la chirurgie robotique, dite également "assistée par ordinateur", ainsi qu’un pionnier de la chirurgie robotique innovante. Ainsi il a effectué en décembre 2004 ce qui était, pour certains comtés du New Jersey, la première prostatectomie (ablation de la prostate) en chirurgie robotique, à l’aide du système de chirurgie assistée par ordinateur da Vinci™, ainsi que, en mai 2005, la première néphrectomie partielle à l’aide de la chirurgie robotique pour le New Jersey (NJ).

Dr. Savatta est l’auteur d’un Blog dédié à la chirurgie robotique en urologie, auquel contribuent ses collègues, chirurgiens urologues travaillant au sein du cabinet Associates in Urology, également utilisateurs du système de chirurgie assistée par ordinateur da Vinci™.

Le ROBOTIC SURGERY BLOG constitue donc le journal de bord de chirurgiens urologues pionniers et utilisateurs de la chirurgie robotique.

Récemment, dans son Blog, le Docteur Savatta et ses collègues ont ouvert un débat autour de la question : comment annoncer à quelqu’un qu’il a un cancer de la prostate ?

Je cite, en les traduisant, les propos du Dr. Savatta : "Annoncer à son patient qu’il est atteint d’un cancer reste un défi pour l’urologue. J’ai récemment eu une discussion animée à ce sujet avec mon collègue qui, comme moi, pratique la chirurgie robotique. Le cancer de la prostate est devenu le premier cancer des organes solides (rein, foie, cœur…) en fréquence pour la population masculine. Il est diagnostiqué à l’aide d’une biopsie pratiquée sur le patient en cabinet de ville. Les raisons pour lesquelles il est souhaite que le patient se fasse faire une biopsie lui sont expliquées par son urologue, lors de la consultation au cours de laquelle une date est fixée pour la biopsie. L’urologue est présent lors de celle-ci. Mes collègues et moi avons discuté des deux options en ce qui concerne l’annonce du cancer : le face-à-face avec le patient et l’annonce par téléphone. Nos opinions divergent.

La première solution consiste à faire revenir le patient pour une consultation et revoir avec lui les résultats de l’examen. Ainsi le patient sera à même d’entendre les explications de son urologue assis en face de lui. Les avantages de cette solution : Le patient est avec son urologue et peut être réconforté par le fait de se trouver dans cet univers médical contrôlé, où on lui communique personnellement un avis médical autorisé. Le patient a le temps d’ 'encaisser' la nouvelle et la possibilité de réagir en posant des questions auxquelles son urologue peut directement répondre. Les inconvénients de cette solution : Le patient attendra plus longtemps pour connaître les résultats de la biopsie. La première réaction correspond souvent à un état de choc, ce qui fait que la mémoire du patient occulte une partie de ce qui s’est passé en consultation. Ainsi, le patient risque de ne pas se rappeler qu’il doit par la suite se rendre à une autre consultation, durant laquelle son urologue lui expliquera les possibilités de traitement qui conviendraient pour son cas.

La seconde solution consiste à annoncer la nouvelle par téléphone au patient. Les avantages : Le temps d’attente du patient pour connaître ses résultats sera réduit au minimum. Le choc causé par la nouvelle pourra être absorbé et le patient sera mieux préparé à la consultation durant laquelle son urologue lui expliquera les différentes possibilités de traitement – consultation qui suivra cet entretien téléphonique. Les désavantages : le patient devra attendre avant de rencontrer son urologue pour discuter des possibilités de traitement. Il se peut que le patient rencontre moins de soutien chez lui que dans l’environnement médical professionnel pour faire face à cette épreuve."

Sur son Blog, le Dr. Savatta appelle usagers de la santé et urologues américains à voter au sujet de la question suivante : vaut-il mieux annoncer la nouvelle au patient au téléphone ou en consultation ? Il souhaite avoir l’opinion des usagers de la santé et des urologues français.

D’où son appel à témoignage :
==> Pour lire les témoignages des urologues et patients américains et voter sur le Blog du Dr. Savatta, cliquer ici. Ce Blog est en anglais.

Et sur ce Blog...

==> Usagers de la santé :
L’annonce d’un cancer : quelle alternative vous semble préférable : l’apprendre au téléphone par votre médecin traitant, ou lors d’une consultation à laquelle vous aurait convié votre médecin traitant afin de vous annoncer la nouvelle ? Souhaiteriez-vous être accompagné de quelqu’un de votre choix lors de cette consultation ?

Vous avez déjà été confronté à ce problème d’annonce d’un cancer (ou l’un de vos proches). Qui vous a annoncé la nouvelle et comment? Auriez-vous souhaité qu’on vous l’annonce autrement ? Ou bien vous n’avez jamais été confronté au problème, ni vous ni l’un de vos proches, vous essayez de vous représenter la situation.

==> Urologues / Infirmiers / Infirmières / Corps médical autre :
Vous souhaitez parler de votre expérience. Quelle option vous est apparue la plus praticable ?

Comment voter et témoigner ?

Vous pouvez voter et laisser votre commentaire en ligne, merci de préciser si vous appartenez au corps médical ou si vous êtes un usager de la santé. Vous pouvez également envoyer votre vote et votre témoignage à l’adresse e-mail suivante : cath.coste@laposte.net. Votre témoignage sera mis en ligne dès réception.

Merci !

Canada : CSTAR

Canadian Surgical Technologies and Advanced Robotics (CSTAR) is a collaborative research program of London Health Sciences Centre (LHSC) and Lawson Health Research Institute (Lawson), and is affiliated with The University of Western Ontario.

"CSTAR is Canada’s national centre for developing and testing the next generation of minimally invasive surgical and interventional technologies and techniques, including robotics. Interdisciplinary project teams are integrating space-age science into surgical procedures from cardiac bypass to cancer therapy."

Robotically Assisted Double Bypass Canadian First at CSTAR

Monday October 24, 2005

"Southwestern Ontario man first Canadian to undergo minimally invasive robotically assisted double bypass surgery

(LONDON, Ontario) – A year ago, Randy Klatt of Corunna, Ontario could barely walk without having pain and a burning sensation in his chest. Now the 52-year-old engineer is taking scuba diving lessons and working out at the gym, due to the success of a minimally invasive double bypass robotic procedure performed at University Hospital, London Health Sciences Centre (LHSC). For the first time in Canada, the procedure called a Multi Vessel Small Thorocotomy (MVST) was completed with the use of the robotic da Vinci® surgical system by an interdisciplinary team of surgeon/scientists from CSTAR (Canadian Surgical Technologies & Advanced Robotics) and Lawson Health Research Institute (Lawson)."

"Heart bypass surgery is one of the most common major operations in Canada. According to the most recent statistics from the Canadian Institute for Health Information, 33 hospitals in this country performed almost 22,500 bypass surgeries in 1998/99.

Conventional coronary artery bypass operations involve the surgeon cutting a long incision into the chest and sawing open the breastbone (sternum) to gain access to the heart. In this way, the surgeon can then fix a clogged artery by sewing a healthy blood vessel into the artery just above the blockage. To perform much delicate stitching, it is usually necessary for surgeons to temporarily stop the heart and put the patient on a heart-lung machine to oxygenate the blood. However, this highly invasive procedure is in sharp contrast to the minimally invasive robotic assisted cardiac surgery on a beating heart conducted at LHSC and this latest Canadian first.

According to CSTAR researcher and LHSC cardiac surgeon Dr. Bob Kiaii, Randy Klatt was the ideal candidate for this procedure as his 2 (double) vessel blockages were in the branches of the left side of his heart. The left side allows for easier access to the blockage through a small incision between the ribs with no requirement to cut the breastbone in half. Innovative endoscopic technology from Medtronic of Canada Limited including a stabilizer (Octopus™), allows the area of the heart that is being operated on to remain stable while the heart is beating. This allows for proper suturing to be performed. An endoscopic positioner (Starfish NS™) also enables the surgeon to expose areas of the heart that are usually not accessible through a small incision. 'Performing this procedure with the addition of robotic assistance enables the harvesting of the artery to be used for the bypass, to be performed by the surgeon more precisely and with greater ease', explains Dr. Kiaii. 'It also is less invasive for the patient and reduces the risk of complications such as post operative inflammation, less pain and makes for a quicker recovery'.

'Four days later I was home with very little scarring and feeling pretty good, ' says Randy Klatt. 'I went back to work very quickly and now I can do any kind of activity I want to including scuba diving'.

Dr. Kiaii and his team have performed close to 90 robotic cardiac procedures (bypass surgery and angioplasty) using the da Vinci® robot including a robotic assisted left atrial appendage ligation, which aids in the treatment of atrial fibrillation.

Dr. Kiaii and Dr. Bill Kostuk were also the first in North America to complete two different procedures to clear 2 blocked arteries during the same episode of care using CSTAR’s specialized Hybrid Operating Room/AngioSuite at LHSC, one of only a few such facilities in the world.

'Innovative research into the use of robotics in cardiac surgery at CSTAR is continuing to revolutionize patient care', says LHSC President and CEO Tony Dagnone, 'and this procedure is another significant achievement we can be proud of'.

According to CSTAR’s Medical Director Dr. Christopher Schlachta, 'In pushing the frontier of minimally invasive robotic surgery, we know that these accomplishments will ultimately improve quality of care and reduce waiting lists'.

This research at CSTAR is supported by grants from the Canada Foundation for Innovation and the Ontario Government."

Source:
C-STAR Canada

USA: video of a robotic hernia repair (digestive surgery) performed during a Prostatectomy case (urology)

Etats-Unis : Hernie digestive opérée en chirurgie mini invasive, en concomitance avec une prostatectomie (urologie) :

About multi-specialty minimally invasive surgery procedures:
Les procédures multidisciplinaires en chirurgie mini invasive :

Here is a video of a robotic hernia repair (digestive/general surgery), performed during a prostatectomy surgical procedure (urology).
La video que nous vous proposons montre une hernie digestive effectuée durant une prostatectomie (urologie).

Both surgical procedures were consecutively performed on the same patient, with a da Vinci™ surgical system.
Ces procédures ont toutes deux été effectuées en concomitance sur le même patient, l'opération en mini invasif a été effectuée avec un système de chirurgie assistée par ordinateur da Vinci™.

The video was shot by Domenico Savatta, MD
Associate in Urology, LLC
Newark Beth Israel Medical Center
New Jersey (NJ)
Cette vidéo a été mise en ligne par le Docteur Savatta, Centre Médical de Beth Israel, Newark, New Jersey, USA.

Why do prostate cancer patients often have to undergo a digestive procedure like hernia repair in succession of the radical prostatectomy case (urology) performed on them? Dr. Savatta about hernia repair procedure during a prostatectomy case:
Pourquoi les patients souffrant d'un cancer de la prostate doivent-ils subir, en même temps que la prostatectomie destinée à soigner leur cancer, une opération traitant la hernie hiatale ? Voici ce que dit le Dr. Savatta à ce sujet :

"Inguinal hernias often coexist in prostate cancer patients. They can sometimes be found on physical exam or during staging CT scans. At the time of transperitoneal robotic prostatectomy the inguinal areas are examined with the robotic scope. If hernias exist, they can be fixed at the time of prostatectomy."
"Les hernies inguinales coexistent souvent avec un cancer de la prostate. Elle peuvent être détectées lors de l'examen du patient ou lors d'une tomographie ou d'un scanner. Lors de la prostatectomie en chirurgie mini invasive par voie transpéritonéale, les régions inguinales sont examinées et apparaissent à l'écran 3D de la console du chirurgien. Si une hernie est détectée, elle peut être traitée chirurgicalement au cours de la même opération".

==> For dsl/cable modem feed of a robotic hernia repair, click here

Hernie hiatale opérée en chirurgie robotique, en même temps que l'ablation de la prostate (prostatectomie, urologie), sur patient atteint d'un cancer de la prostate :
==> Vidéo (nécessite une connection à internet en haut débit)

==> Access Dr. Savatta's Robotic surgery Blog: click here.

Blog de chirurgie robotique du Dr. Savatta (urologie): NB: ce Blog est en anglais.
==> cliquer ici.

Urology: the Robotic cancer web site

Bloodless Prostate Cancer Surgery

"The last few years have been witness to significant advances in our ability to treat prostate cancer. Surgery has been the gold standard of treatment for cancer cure, but complications of impotence and incontinence, prolonged hospital stays and risks of blood loss have been cited as incentives for patients to seek out less invasive approaches, even if success rates were not quite as high. ROBOTIC PROSTATECTOMY represents a quantum leap forward in our ability to effectively treat prostate cancer, reduce hospital stays, and minimize the risk of complications. In addition, in my opinion, the long term sexual and urinary bother symptoms will be less than for current surgical techniques or any form of radiation therapy as well."

==> View Robotic Surgery Urology Procedures: click here.

What is Robotic Surgery?
Read more: click here.

"Robotic surgery is an extension of laparoscopic surgery. Most people are familiar with laparoscopy. Surgery is performed by manipulating straight instruments while viewing the instruments on a monitor. Robotic surgery is the evolution of laparoscopy that addresses the drawbacks of laparoscopy.

One obstacle of laparoscopy is the loss of 3-D spatial relationships since the 2-D monitor is used to operate. The da Vinci Surgical System® uses a laparoscope that is comprised of 2 cameras and lenses to provide the surgeon with a true minimally invasive 3-D view of the surgical field including depth of field, magnification and high resolution.

Laparoscopic instruments have the feel of "chop sticks". The da Vinci Surgical Cart® includes the EndoWrist ® Instruments. The EndoWrist® Instruments are designed to mimic the movement of the human hands, wrists and fingers. The extensive range of motion allows precision that is not available in standard minimally invasive procedures.

Laparoscopic surgery places the surgeon in an uncomfortable position that can lead to a higher rate of surgical errors. The Da Vinci Surgeon Console® contains the master controls that the surgeon uses to manipulate the EndoWrist® instruments. The handles or 'Masters' translate the surgeon's natural hand and wrist movements into corresponding, precise and scaled movements. The EndoWrist Instruments® are only able to move when commanded by the surgeon. There is a clutch that deactivates the instruments and allows the surgeon to maintain a comfortable position at all times."

How does the robot work?

"The da Vinci® Surgical System combines proprietary software and electronics that create surgical immersion. The Surgeon's Console gives doctors the control and ability to navigate inside the patient. The InSite® Vision System immerses surgeons in a true-to-life 3-D image. The Navigator™ Camera Control allows the surgeon to easily change, move, zoom and rotate his or her field of vision. The camera can be repositioned quickly and smoothly within the surgical opening without disrupting the procedure.

The EndoWrist®Instruments transform movement of the doctor's wrists, hands and fingers into movement of the tiny instruments.

The da Vinci® Surgical System is the only commercially available technology that can provide the surgeon with the intuitive control, range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through small ports of minimally invasive surgery.

Using the da Vinci® System, surgeons can operate with the look and feel of open surgery, performing complex surgical maneuvers through 1-cm ports."

What makes robotic surgery better?

"With its 3-D view, the da Vinci Surgical System aids the surgeon to more easily identify vital anatomy such as the delicate nerves and blood vessels surrounding specific anatomy. The EndoWrist® Instruments provide the surgeon with the dexterity not available using conventional laparoscopic instruments to perform a delicate and precise surgical dissection , reconstruction or removal of specific tissue. The da Vinci® Surgical System is groundbreaking technology that extends the surgeon's capabilities in the following ways:

=> Enhanced 3-D Visualization: Provides the surgeon with a true 3-dimensional view of the operating field. This direct and natural hand-eye instrument alignment is similar to open surgery with 'all-around' vision and the ability to zoom-in and zoom-out.

=> Improved Dexterity: Provides the surgeon with instinctive operative controls that make complex MIS (Minimally Invasive Surgery) procedures feel more like open surgery than laparoscopic surgery.

=> Greater Surgical Precision: Permits the surgeon to move instruments with such accuracy that the current definition of surgical precision is exceeded.

=> Improved Access: Surgeons perform complex surgical maneuvers through 1-cm ports, eliminating the need for large traumatic incisions.

=> Increased Range of Motion: EndoWrist® Instruments restore full range of motion and ability to rotate instruments more than 360 degrees through tiny incisions.

=> Reproducibility: Enhances the surgeon's ability to repetitively perform technically precise maneuvers such as endoscopic suturing and dissection."

=> The Robotic Operating Room:

1. What does an operating room need to house a da Vinci robot?
2. What staff are required?

"The only requirement for the operating room is the operating room size. The unit consists of a console that the surgeon sits at and the robot that needs to be wheeled in towards the patient. These pieces cant be too close while the patient is entering the OR suite as you need to have freedom for people to walk around.

The other components for the operation are components you would need for all surgery or laparoscopic surgery.

Laparoscopic equipment: TV monitors for the assistant and nurses, air insufflator, light source.

Standard equipment: cautery generators, suction canisters, anesthesia setup.

In our hospital there is only 1 room that is large enough for the robot to work in. The robot, although weighing in excess of 1000 pounds (I think) is relatively easy to move around. We move it to other parts of the operating room to practice with it and easily move it around the room between cases if we are doing 2 different operations that day.

Our hospital is building 3 state of the art laparoscopic suites which should have all the screens and lap equipment hanging from the ceiling. I am told there will be a 42 inch plasma on the wall for everyone in the OR to see. Teleconferencing will also be available and my expectation is to have surgeons from all over the country and world come learn how to do some of the advanced robotic procedures we are doing at NBI currently.

I am hoping that the next generation of robots will be integrated into the operating theaters and will need less space.

What staff are required?
The main difference between this surgery and previous surgeries is that the surgeon is not at the field. I am currently performing surgeries with another urologist, but plan on hiring and training a physician assistant or nurse first assist to help. 90% of the operations can be just as safely, quickly, and precisely performed with a qualified non-physician assisting after the learning curve has been passed.

The anesthesia requirements are the same as any surgery except a full general anesthetic is needed (not a spinal). The blood loss is much less, as are the fluid shifts as compared to open surgery, so I would consider most cases low stress for the anesthesiologist.

The scrub nurse is the same as any operation. She does much less work than open once there is an experienced robotic team since the amount of instrument changes, sutures, etc. is less as compared to open surgery.

The circulating nurse is also necessary, as we sometimes use different devices from special clips or staples depening on the anatomy.

The only time that additional people are nice to have in the room is the setup and docking of the robot and the removal of the robot. We have developed several ways to remove steps to make this process as streamlined as possible.

Compared to open or lap surgery, the staff requirements are similar. The room size is the only difference with a large room needed for robotics."

Sources:
1.- Associates in Urology: da Vinci® Prostatectomy Robotic Surgery
==> Link to the web site: click here.

2.- Blog:
==> ROBOTIC SURGERY BLOG: click here.

"Haptics - A robotic limitation:"

"The most cited drawback of robotic surgery is the loss of fine feeling of the instruments on tissue.

The other drawbacks are the expense of the surgical system and the need for precise positioning of the robotic arms to provide for a full range of motion without repositioning the arms.

Haptics refers to the feedback of moving the robotic controls on the surgeon.

The current version of the da Vinci robotic surgical system does not have haptics Incorporated into the system. I admit it would be nice for the next version of the system to have haptics and enable the surgeon to feel the tension on sutures, as well as the tension of instruments on tissue.

The robotic radical prostatectomy procedure is a delicate urologic procedures that is a good one to use in discussing haptics.

In my opinion, the loss of feedback is not a major or significant drawback. Although I think it will make the robot easier to use and possibly a little safer, the 10 times magnification more than makes up for this shortfall. We have different senses that are used to some extent in surgery. The sense of sight allows us to see tension in tissue and sutures. As long as the instruments are kept in the field of view, the loss of fine sense of feel is not a problem for me.

There is a limited sense of feel with the da Vinci. When instruments have tension, eventually it will be felt in the instruments. When I am retracting the prostate with my left hand, I feel the tension when it gets to a certain level, granted not as soon as I would with me hands. When I lift on the vas and seminal vesicles with my 4th arm, I can feel the tension in the instrument. If my instruments are colliding with each other, or with the bony side wall, or with a laparoscopic instrument the instruments don't move as smooth as usual.
To date I have performed 65 robotic operations and 49 prostate operations and have not had any complications related to lack of haptics. I haven't had any vessel or bowel injuries."

Continue reading: "Haptics - A robotic limitation":
==> click here.

La valise diplomatique. Une fiction médicale

Je me suis décidée à écrire sur ce sujet aux frontières entre la vie et la mort, la mort et la vie, un no man’s land où nous, chirurgiens et chirurgiennes, procédons en passeurs anonymes à des échanges clandestins. Nous passons ces frontières en clandestins : «Non, je n’ai rien à déclarer» (ce territoire ne fait pas encore partie de l’espace Schengen). «Valise diplomatique !». Je brandis mon I.D. justifiant mon Immunité Diplomatique, et je franchis sans histoire les frontières successives, avec ma précieuse valise, que personne ne m’a demandé d’ouvrir. En général, à ce moment là, des images m’accompagnent : un ange aux ailes de sang. Pourquoi du sang ? J’ai dû essayer de faire rentrer mes ailes dans les gants chirurgicaux. Pas précisément adaptés. Je saigne, je sais, ça fait partie du métier. «Le sang coule, c’est le métier qui rentre». «Ce qui ne détruit pas rend plus fort». Ces phrases reviennent souvent dans la bouche de mes collègues. Des phrases pour cimenter les briques des épreuves.

Quand j’étais étudiante en première année de médecine, l’année du redoutable concours, l’amphi était bondé en début d’année. Un de nos profs procéda à un écrémage selon une recette maison, sans attendre le concours : «En faisant médecine, vous vous préparez à passer votre vie dans le sang, l’urine, la merde et le vomi. Ceux que ça gêne, il faut qu’ils partent à côté : ils apprendront à vendre des savonnettes». Trois cours plus tard, un bon quart des étudiants avait déserté l’amphi pour de bon. A la grande satisfaction du prof. En même temps que le sang et compagnie, il aurait dû mentionner le manque de sommeil. Parler du sommeil à un «chir.» (c’est comme ça qu’on nous appelle dans le métier) équivaut à parler du sucre à un diabétique. Orgie de douceur vengeresse qui me traverse, dans le sillage de l’ange aux ailes de sang.

Depuis 5 ans, je supervise les internes dans le service de chirurgie pédiatrique d’un grand hôpital parisien. Les usagers de la santé nous tiennent pour des scientifiques, des grands prêtres de la Science Exacte : chirurgie assistée par ordinateur pour opérer les organes mous en endoscopie, chirurgie au laser, robot pour opérer la cataracte, système high-tech de chirurgie assistée par ordinateur pour la pose de prothèses de genoux : la précision chirurgicale est devenue numérique. La chirurgie, c’est Matrix ; le chirurgien, c’est James Bond. Comme l’espion britannique de Sa Majesté, j’utilise la technologie de pointe en m’efforçant de ne pas faire de vagues. «Painless civilization». C’est le package que l’hôpital vend à l’usager de la santé. Un ami qui est comptable dans une clinique privée m'a repris l’autre jour : «Tu ne dois plus parler de malade ou de patient. Il faut parler de client». Je lui ai répondu : «Pour une fois que la compta et le marketing s’entendent !... D’habitude, le marketing dépense des sous et la compta râle».

«On va opérer votre petite Mélanie en chirurgie mini invasive, à cœur battant. Pas besoin de lui ouvrir la cage thoracique, il suffira de pratiquer quelques incisions minimes. Pas besoin de lui casser les côtes, pas besoin non plus d’utiliser le CEC (Système de Circulation Extracorporelle) qui gère l’arrêt temporaire du cœur et des poumons, la circulation du sang s’effectuant en 'itinéraire bis' pendant ce temps, grâce à une machine qui relaye les fonctions cardio-pulmonaires, tout ceci après ouverture de la cage thoracique et écartement des côtes. Lorsqu’on utilise cette méthode de chirurgie traditionnelle invasive, on opère ‘à ciel ouvert’, comme disent les chirurgiens. Pour Mélanie, plus besoin de tout ça. Par les toutes petites incisions qu’on pratiquera sur son thorax, on entrera les instruments destinés à opérer. Un chirurgien assis à une console équipée d’une image en 3D et d’un système infrarouge commandera, ou téléguidera, si vous voulez, les mouvements des instruments opérant à cœur battant. Vous voyez, ce n’est pas le robot qui opère, c’est le chirurgien, pour autant plus besoin d’ouvrir le thorax et d’utiliser la CEC. Rassurez-vous, c’est une opération pratiquée couramment aujourd’hui, votre petite fille sera sortie de l’hôpital et totalement rétablie en 3 jours». Tandis que je parle ainsi à la mère de ma petite patiente de 6 ans, l’ange aux ailes de sang me traverse à nouveau, cette fois-ci, il opère à ciel ouvert. Le fruit de vos entrailles est béni !

Chirurgie mini invasive, coelioscopie, etc. : je suis une chirurgienne informatisée, et je veille à avoir les derniers logiciels. Ils viennent de Californie. Silicon Valley, l’université de Stanford, l’UCLA (University of California, Los Angeles), etc. Le progrès est relégué au grenier. Nous sommes à l’ère des technologies, biotechnologies, bioéthique, éthique médicale. L’autre jour j’ai lu un article dans le NEJM, le très sérieux «New England Journal of Medicine», écrit par un «Medical Bioethicist PHD». J’ai mis un moment avant de déchiffrer ce que recouvrait exactement ce terme barbare. C’est dans la langue de Shakespeare, mais ce n’est pas du Shakespeare ! En salle de garde, un interne résume la situation : «La biotechnologie, c’est de la technologie bio. Et la bioéthique, c’est pour réfléchir là-dessus. Internet ; l’intranet et l’extranet, tout ça c’est bio, comme 'la Vie Claire'. Puisqu’on nous promet des écrans organiques pour nos ordinateurs de demain… Jamais entendu parler des écrans OLED ?»

Lire la suite (Format PDF) : cliquer ici.

Blog sur la Transplantation d'Organes / Organ Transplantation Blog

Blog Bilingue d'informations destinées au Grand Public concernant les Transplantations d'Organes :
(Articles en français et en anglais)
==> Cliquer ici.
Date de création du Blog : mai 2005.

Bilingual Blog with Information intended for a Broad Public, regarding Organ Transplantation:
(with Articles in English and in French)
==> Click here.
Blog created in May 2005.

CHIRURGIE ROBOTIQUE : LES NEWS / ROBOTIC SURGERY: THE NEWS

La chirurgie robotique évolue à pas de géant !...
Expérimentée dès 1995, elle est en pleine évolution aujourd'hui.
Suivez l'actualité !

==> Accéder au Blog Bilingue des News (français et anglais).

Welcome in the high-paced world of Robotic Surgery!
The adventure started in 1995, and now a revolution is taking place:
Minimally Invasive Surgery (MIS) is replacing invasive surgery.
To keep up with this spectacular evolution, check the News Blog out!

==> Access the Bilingual News Blog (English and French).

Le système de chirurgie assistée par ordinateur da Vinci™ à l'Institut Mutualiste Montsouris, Paris

L'Institut Mutualiste Montsouris (IMM), Paris 14ème, est un établissement privé et public à la fois. Ni clinique, ni hôpital publique (Assistance Publique des Hôpitaux de Paris, AP-HP), cet établissement a un statut particulier.

Le Professeur Guy Vallancien, à la tête du Département d'Urologie à l'Institut Mutualiste Montsouris :

**** Contribue à développer la robotique opératoire.

=> voir également le site : UroLaparo.org

**** Enseigne les nouvelles techniques chirurgicales à l'Ecole Européenne de Chirurgie, Paris, qui est équipée pour fournir une formation de haut niveau tant théorique que pratique.

==> Ecole Europeéenne de Chirurgie (eec-fr.com)

**** Contribue au développement de réseaux de collaboration ou partenariats avec l'IMM.

Robotic surgery: Frequently Asked Questions (FAQ)

da Vinci™ robotic surgical system:

Frequently asked questions: click here or read below:

1. Will a surgeon using the da Vinci® robotic surgical system operate in “Virtual Reality?”

Although seated at a console a few feet away from the patient, the surgeon views an actual 3-D image of the surgical field while operating, real-time, with electro-mechanically enhanced instruments through tiny ports. At no time does the surgeon see a virtual image or program/command the system to perform any maneuver or operate outside of his/her direct, real-time, control.

2. Will the da Vinci® robotic surgical system make the surgeon unnecessary?

On the contrary, it will enable surgeons to be more precise, advancing their technique and enhancing their capability to perform complex minimally invasive surgery.

3. Is this telesurgery? Can you operate over long distances?

The da Vinci Surgical robotic surgical system theoretically be used to operate over long distances. This capability, however, is not the primary focus of the company and as such is not available with the current da Vinci system.

4. Is this “robotic surgery?”

“Robotic surgery” devices are designed to perform entirely autonomous movements after being programmed by a surgeon. The da Vinci system is a computer-enhanced surgical system, which interposes a computer between the surgeon’s hands and the tips of micro instruments. The system replicates the surgeon’s movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver.

5. Where is the da Vinci system being used now?

Currently, the da Vinci Surgical System is being used in major centers in the United States, Austria, Belgium, Denmark, France, Germany, Italy, Japan, the Netherlands, Sweden , Switzerland and the United Kingdom.

6. What procedures have been performed using the da Vinci? What additional procedures are possible?

The da Vinci system is a platform technology designed to enable complex procedures of all types to be performed through tiny ports. To date, hundreds of procedures including cardiac, general, urologic and gynecologic have been performed using the da Vinci. We believe, in the future, the technology will be used by surgeons specializing in vascular, orthopedic, spinal, neurologic and other surgical disciplines to offer their patients the option of minimally invasive surgery for the first time.

7. Why can’t surgeons perform complex procedures such as cardiac surgery through 1-centimeter ports today?

Cardiac surgery is complex and requires an excellent view of the operative field and the ability to maneuver instruments within the chest cavity with precision and control. Surgeons historically have used the “open sternotomy” approach, which requires a large 12-inch incision that provides visibility and allows room for the surgeon to get his hands and instruments very close to the operative site. More recently, smaller incisions have been used to perform a variety of cardiac procedures. Many surgeons, however, feel the smaller access restricts operative view and may impede access to the operative field.

8. What are the benefits of using the da Vinci system?

For the surgeon, the ability to perform complex minimally invasive procedures as if they were open surgery. For the patient, numerous benefits common in existing minimally invasive surgery procedures - such as reduced trauma, less pain, lower cost, shorter hospital stay and faster recovery are possible.

9. Has the da Vinci system been FDA approved?

On July 11, 2000, Intuitive Surgical received clearance from the FDA to begin commercializing the da Vinci Surgical System in the United States for use in laparoscopic surgical procedures. Additionally, on March 2, 2001, the manufacturer received its second FDA clearance for thorascopic procedures. And on May 30, 2001, the FDA cleared the da Vinci Surgical System for laparoscopic radical prostatectomy procedures. This makes the da Vinci Surgical System the only FDA-cleared, complete robotic surgical system commercially available in the United States for laparoscopic and thoracoscopic procedures.

Source:
University of Iowa Healthcare.

Robotic Surgery and FDA Approvals

The da Vinci™ surgical system has been FDA approved to assist in urologic surgery, thoracoscopic (chest) surgery procedures, general surgery: general (digestive) laparoscopic procedures, gynecological laparoscopic procedures, coronary artery bypass surgery, mitral valve repair and cardiac revascularization.

In urologic procedures, the system is being used to perform radical prostatectomy, a minimally invasive radical prostate cancer surgery that profoundly reduces bleeding, pain, and recovery time. Intuitive Surgical noted that the da Vinci™ Surgical System has been successfully used in thousands of prostate cancer procedures world-wide.

In cardiac surgery, the system is being used to perform single or double vessel Beating Heart TECAB (Totally Endoscopic Coronary Artery Bypass), also called single or double vessel Beating Heart CABG (Coronary Artery Bypass Graft). This means surgeons currently perform single vessel or double vessel Coronary Artery Bypass Graft on patient's beating heart, with minimally invasive technique (closed-chest technique, keyhole surgery). In these cases, surgeons no longer need to crack patient's chest open (break patient's chestbones) and put patient's heart on the off-pump system to operate on an arrested heart (invasive, open-chest cardiac surgery).

History:
On July 11, 2000, Intuitive Surgical received clearance from the FDA to begin commercializing the da Vinci™ Surgical System in the United States for use in laparoscopic surgical procedures.

Additionally, on March 2, 2001, the manufacturer received its second FDA clearance for thoracoscopic procedures. And on May 30, 2001, the FDA cleared the da Vinci™ Surgical System for laparoscopic radical prostatectomy procedures.

On November 13, 2002, Intuitive Surgical's da Vinci™ surgical system received first FDA Cardiac Clearance for Mitral Valve Repair Cardiac Surgery.

On January 30, 2003, the FDA Clearance for Intracardiac Surgery now encompasses "ASD" Closure (Atrial Septal Defect Closure surgical procedure).

On July 8, 2004, Intuitive Surgical received clearance from the FDA for Cardiac Revascularization with the da Vinci™ surgical system.

On April 26, 2005, Intuitive Surgical received clearance from the FDA for Gynecological Laparoscopic procedures with the da Vinci™ Surgical System.

This makes the da Vinci™ Surgical System the only FDA-cleared, complete robotic surgical system commercially available in the United States for laparoscopic and thoracoscopic procedures.

*** Intuitive Surgical receives FDA Clearance for Gynecological Laparoscopic procedures:
=> read.

*** Intuitive Surgical receives FDA Clearance for Cardiac Revascularization:
=> read.

More about laparoscopic and thoracoscopic surgical procedures with the da Vinci™ surgical system:

=> IntuitiveSurgical.com
=> daVinciProstatectomy.com

Source:
=> MarketWire.com