REGINA MARIA Hospital Cluj-Napoca has acquired modern software in urological robotic surgery, the only one of its kind in the country, which allows robotic surgery to be performed with maximum precision.

The Synapse 3D software allows for a three-dimensional reconstruction of both the kidney tumor and the local anatomy, helping the surgeon and medical team to make the right intervention decision for each patient.

This software three-dimensionally processes the information obtained during computed tomography, explains Professor Dr. Nicolae Krishan, chief urologist specializing in minimally invasive laparoscopic and robotic surgery and uro-oncology. “For example, if we have a patient with a 4-centimeter tumor in the left kidney, computed tomography (CT) makes slices down to one millimeter and examines the patient’s kidney. And this will give different information about the position of the tumor in the kidney – on the upper or lower pole, on the front or back surface of the kidney, close to the renal pedicle or far away. . In addition, if it is closely related to the urinary tract. If it has completely endophytic development in the kidney or exophytic – that is, outside the kidney. So this is the information that CT gives us. And this is the information that forms the basis of our decision about surgery and especially the type of surgery.”

In addition to the information provided by the CT scans, the new software processes them, creating a three-dimensional reconstruction of the anatomical reality at the level of the kidney. “And very precisely, I can accurately determine the appearance of the tumor, the connection with the kidney, blood vessels, urinary tract,” the professor adds.

“While the entire kidney was removed”

Why are these things important? There are two important aspects, the university says: “This three-dimensional reconstruction made by the software creates a clear picture of the disease for me. And secondly, it creates a clear picture for me about the most suitable treatment. Because what we do with these patients is kidney-sparing surgery. That is, we remove only the tumor mass and preserve the kidney. We don’t let the patient lose a kidney.”

To date, total nephrectomy has been performed. The entire kidney was removed because it was believed that there was a tumor in it and it should be removed, the expert adds: “Currently, we are trying to remove the tumor and save the kidney. And this 3D software helps us understand exactly whether we can save the kidney or not. And, above all, it helps us during the operation to know where the noble structures are, represented by vessels, urinary tracts, where is the normal parenchyma, and where is the tumor. Thus, operative interventions become very precise.”

“You better understand where you need to sort out”

The intervention is carried out with the help of robotic surgery, which involves minimal incisions of 8-9 millimeters, through which robot arms are introduced into the abdominal cavity. “Robotic surgery is minimally invasive. On the one hand, it is minimal incisions, on the other hand, it is an image-based operation. The robot offers you extremely clear images from inside the abdominal cavity. And then you understand well where to dissect, where to cut, where to work.

The new software allows intraoperative support of the surgical gesture with very high precision. During the intervention, I can stop, recheck the 3D reconstruction provided by the software, continue the dissection, and then again I can stop, go back, look at the 3D reconstruction again, better understand where the anatomical elements are, and go back to the surgery,” they explain. at the University.

The software is only used for kidney tumors, Professor Krisan notes.

“It takes 10 minutes, not a whole day”

Dr. Paul Medan, a urologist specializing in robotic surgery, highlights other benefits of the new software: “In the past, we have done 3D reconstructions for patients with kidney tumors. Where the goal is to remove only the tumor and preserve the kidney. This is a rather complex operation, during which it is very well to know the connection of the tumor with the kidney itself, with large vessels, with the collector system, where the urine is diverted.

There are very time-consuming ways to find out all this. The new software performs all these reconstructions automatically, based on the information received in the TC. It takes 10 minutes to make an appropriate reconstruction, not a whole day,” the specialist emphasizes the importance of software in preoperative preparation.

Another advantage of the software is that it greatly simplifies the discussion with the patient and relatives. Because on the basis of such a reconstruction, doctors can present and explain to them what intervention can be done and for what. “If we can’t do kidney-sparing surgery, patients can understand why we had to remove the whole kidney and we couldn’t do kidney-sparing surgery,” adds Dr. Paul Medan.

In addition, the software allows us to simulate surgical interventions: “The software shows us which vessels were involved, whether the collecting system was open, and tells us what to look for during surgery so that we can do the surgery as we want. “, he concludes. Dr. Medan.

The robot, the most important innovation in modern surgery

Robotic surgery has great benefits for patient safety and recovery. PHOTO: Queen Mary

Professor Dr. Vincenzo Ficarra from the University of Messina, Italy, present at the surgery using the new software at Regina Maria Cluj-Napoca, said he was excited about the new technology: “It is a great opportunity to share with colleagues – with Professor Coman, who is an expert in minimally invasive surgery in Europe, and with Professor Krisan – this experience. It was a good opportunity to see and operate on a robot that is truly the most important innovation in surgery today. Professors Crisan and Coman are doing a very good job promoting robotic surgery in Romania.”

For his part, University Professor Emeritus Dr. Ioan Coman, one of the first trainers of the medical teams noted that for more than ten years in Cluj, urological surgeons were trained to work with robots. “Romania is at least among the countries that have the appropriate equipment in the field of urology. Robotics at home in Romanian urology. We have been studying robotic surgery for 15 years. She was born here in Cluj, in the municipal hospital with the team I coordinated while I was head of department and professor at UMF Cluj-Napoca. Since then and until now, teams of surgeons have been formed, convinced of the advantages that robotics brings: surgical safety, precision, minimal invasiveness – which means minimal pain and quick postoperative recovery – short hospitalization, social and family reintegration in the shortest possible time,” he explained. Professor John Coman.

See more about the new software purchased in Cluj in this video:

The article was approved by Queen Mary