The frontiers ofArtificial intelligence they know no bounds and expand into oncological surgery. After the development of algorithms to quickly diagnose the presence or absence of Covid-19 in patients, a 62-year-old woman in Turin was subjected to a wake-up call surgery to remove a malignant tumor in the kidney by the hand of a surgical robot. This is the first surgery of this kind in the world, performed in the University Urology Department of Molinette in Turin.
After defeating a malignant tumor years earlier by removing a lung, the patient lived with an ever-expanding kidney tumor, which could not be removed due to severe respiratory problems.
I had already been visited in various Italian centers of excellence, – says the patient, as reported by the national press – where they told me that the only therapy was the removal of the mass, but the anesthetists envisaged a risk of 80% of don’t wake me from surgery.
The mass had reached five centimeters and had gained depth, making surgery essential to prevent the spread of the tumor. The doctors immediately rejected the laparoscopy, which would have involved the risk of unleashing a further expansion of the mass, as well as the traditional surgery, which could have caused serious complications.
The solution seemed from the beginning only one: the robotic surgery performed through the innovative Da Vinci robot.
“The robotic technology, the only one that would have allowed us to remove a tumor of that size and save the kidney, had never been used in an awake patient, so I was unable to guarantee the feasibility of the surgery”, he says. Paolo Gontero, professor of the hospital’s urology department.
The patient underwent a “continuous thoracic spinal anesthetic block” to anesthetize the kidney area and remained alert for the entire duration of the surgery, which was two hours. The crucial problem was precisely that of being able to obtain an optimal level of peripheral anesthesia that allowed the woman not to feel pain and to remain awake and immobile during the entire duration of the operation, a factor that allowed the robot Da Vinci to operate safely. If this had not been possible, general anesthesia would have had to be used, from which the patient might not have awakened.
The surgery was conducted with a retroperitoneoscopic technique with the robot Da Vinci Xi. The Da Vinci is the most advanced robotic system for minimally invasive surgery with multiple applications: from thoracic surgery to general surgery, from gynecology to urology, passing through otolaryngology. Is composed by four robotic arms, three of which hold instruments such as scalpels, scissors and cattle (electrocautery instruments), while the fourth holds a camera with two lenses that guarantees the surgeon a complete view of the console in stereoscopy. In this way, the surgeon sits at a control panel and observes a three-dimensional image of the surgical process through two viewfinders, while operating the arms with two pedals and two manual controls.
Although it is a robot, the surgery is not performed autonomously by a computer: in fact, the expert hand of a surgeon always operates this technology. The hope is that in the future Artificial Intelligence will be able to operate in complete autonomy also in this area, accelerating the pace of progress and laying the foundations for a real revolution.
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