AGI – For the first time in the world a Surgical robot has removed a malignant kidney tumor on an awake patient, at the University Urology Department of the Molinette hospital of the City of Health of Turin. A 62-year-old woman, after having defeated a tumor many years earlier thanks to the removal of a lung, was now living with a kidney mass that continued to grow and could not be removed. The operative risk was too high due to her respiratory problems.
“I had already been visited in various Italian centers of excellence, where they told me that the only therapy was the removal of the mass – says the patient – but the anesthesiologists offered me an 80 percent risk of not waking up from the operation “. The patient then turns to the Molinette hospital in Turin.
Meanwhile the kidney mass had grown significantly over the past few months to over 5 centimeters and was very deep. The operation was now of an urgent nature both for the risk of tumor spread and for the impossibility of removing only the mass, saving the kidney if it had grown again.
“When I examined the documentation, I immediately told the patient that the case was extremely complex because robotic surgery, the only technology that would have allowed us to remove a tumor of that size in a minimally invasive way, saving the kidney, had never been used. in an awake patient and therefore I was not able to guarantee the feasibility of the operation “, explains Paolo Gontero, director of university urology at the Molinette hospital.
“The choice of the Da Vinci robotic system was obligatory because I did not consider it safe from an oncological point of view to adopt the pure laparoscopic technique due to the risk of ‘spreading’ the tumor, since it was a ‘liquid content’ mass in a patient who risked moving On the other hand, ‘traditional’ open surgery exposed to too high a risk of complications, “he adds.
The intervention was planned thanks to the coordination activity carried out by Roberto Balagna, director of the Anesthesia Resuscitation hospital at the Molinette hospital, and Luca Brazzi, director of the Anesthesia Resuscitation University Molinette. The crucial problem with the surgery was getting a optimal level of peripheral anesthesia so that the patient not only does not feel pain but remains awake and motionless throughout the surgery.
Otherwise, the rigid working arms of the Da Vinci system could not have operated safely. Failure to achieve these goals would therefore have implied the need to resort to general anesthesia from which the patient could never wake up. (AGI) Red / Pot
When the patient entered the operating room, the anesthetists Fabio Gobbi from the Balagna team and Paola Rampa from the Brazzi team were waiting for her. Gobbi, with an innovative technique, practiced a “continuous thoracic spinal anesthetic block”, thus making the patient “numb” in the kidney area.
The surgery was conducted by Paolo Gontero, through the use of a retroperitoneoscopic technique with the Da Vinci Xi robot and the use of 4 operating arms. The patient, alert, was able to follow the various phases ofintervention that took place in 2 hours of robotic time. Despite the size (which exceeded 5 cm) and the deep growth of the mass, thanks to the combination of the robotic technique assisted with the Da Vinci system and innovative technologies of three-dimensional reconstructions of the images that guided the intervention, the malignant tumor is been removed completely saving the kidney.
“It was a great emotion for everyone in the operating room when, upon my notification of the success of the surgery, the patient (still attached to the robotic arms) burst into tears of joy saying ‘Thank you for giving me a second life’, says Gontero, who concludes: “Thanks to the strength and courage of this patient and the collaboration of a highly professional team, we have demonstrated for the the feasibility of using robotic technology while awake was the first time in the world“.
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