For the first time in the world, a surgical robot intervenes on an awake patient. The surgery was performed in Italy, at the Molinette hospital of City of Health of Turin, in the department of university urology. The robot removed a malignant tumor from a kidney of a patient who remained alert and present throughout the operation. The surgery lasted about two hours. The tumor was removed completely, saving the kidney.
The case concerns a 62-year-old woman who had already defeated another lung cancer in the past. Now he found himself “living with a kidney mass which continued to grow and which could not be removed. The operative risk was too high due to his respiratory problems ”as explained by the City of Health which communicated the news. A difficult problem to face and which seemed to have no way out.
Exceptional intervention with a surgical robot at Molinette di Torino
“I had made several visits to Italian centers of excellence where they told me that the only therapy was the removal of the mass ”, says the lady in the note. "But the anesthesiologists offered me an 80% risk of not waking up from the surgery." Taken by desperation, the patient goes to the Molinette hospital in Torino. The kidney mass was very deep and had grown significantly over the past few months to over five centimeters. The intervention was now of an urgent nature both for the risk of tumor spread and for the impossibility to remove only the mass, saving the kidney if it had grown further. A complex case. Robotic technology appeared to be the only solution, but it had never been tried before in an awake patient.
The "traditional" surgery too risky for the patient
Explain the teacher Paul Gontero, Director of University Urology at Molinette hospital: “When I examined the documentation, I immediately told the patient that the case was extremely complex. Robotic surgery was the only technology that would allow us to remove a tumor of that size in a minimally invasive way, saving the kidney. An awake patient had never been operated on with this technique, so I could not guarantee the feasibility of the operation ".
“The choice of the Da Vinci robotic system - he added - was obliged 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 is a "liquid mass" in a patient who risked moving during the operation . On the other hand, the "traditional" open surgery exposed to too high a risk of complications ".
Patient awake but immobile thanks to optimal peripheral anesthesia
Il doctor Roberto Balagna, director of the Anesthesia Resuscitation hospital of Molinette, and the Professor Luca Brazzi, director of the university resuscitation anesthesia coordinated planning the intervention. The crucial problem was being able to obtain an optimal level of peripheral anesthesia so that the patient not only did not feel pain but still remained 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 objectives would have implied the need to resort to general anesthesia. In this case the patient would have run the risk of never waking up again.
Fabio Gobbi of the Balagna team and Paola Rampa of the Brazzi team are the anesthetists who welcomed the woman into the operating room. Here too an innovative technique: Dr. Gobbi practiced a “continuous thoracic spinal anesthetic block”, thus making the patient “numb” in the kidney area. Professor Paolo Gontero himself, assisted by doctors Marco Oderda and Giorgio Calleris, conducted the surgery. The malignant tumor was completely removed, despite its large size (exceeding 5 centimeters) and its deep growth. The kidney was saved. Great emotion from everyone in the operating room when Professor Gontero communicated the success of the operation. "We have demonstrated for the first time in the world - he said - the feasibility of using robotic technology while awake".
Photographs kindly granted by the press office of the Molinette Hospital in Turin.
