tronella | Black Pean - Darwin information #3

Spoilers up to episode 5.

Vol. 3: Having Da Vinci surgery - from examination to discharge

Robot-assisted surgery appeared in episode 5. There are probably many people who want to know its specific characteristics and what they should know from the perspective of a patient. This time, Dr Watanabe will tell us about Da Vinci surgery from examination to discharge and its comparison with typical surgery by thoracotomy.

What diseases is the Da Vinci surgical system used for?

The aim of Da Vinci (robot)-assisted surgery is often to treat mitral insufficiency.

Even people who are diagnosed with mitral insufficiency at another hospital are referred to this hospital hoping to receive Da Vinci surgery. Also, a lot of patients at this hospital have done their own research and come to get Da Vinci surgery by themselves. In April, this type of surgery started to be covered by insurance, so there are also people who learned about it that way.

What are the characteristics of Da Vinci surgery?

1. The incisions are small, so there is less bleeding.

Unlike thoracic surgery, the surgery is performed without a large incision, just cutting a hole of a few centimeters, so there is almost no bleeding and transfusion is rarely required. Making smaller incisions also reduces the pain, and recovery is also quicker, of course. I think that is the greatest benefit of Da Vinci surgery.

But it’s not just that the holes are small so recovery is faster, but the total time for the surgery is shorter so recovery is faster. However small the holes are, if it took longer than a normal thoracic surgery, it would be meaningless. If it goes about as smoothly and quickly as a normal thoracic surgery, then the small holes place less burden on the patient.

Also, depending on the person, it can often be very important to make smaller incisions, particularly in women, so we could call that an advantage for those people.

2. Reduced postoperative pain and speed of recovery.

If Da Vinci surgery is performed in the morning, the patient usually recovers from the anaesthetic at around 3 or 4 pm, so no intubation is required. By evening, they can get out of bed, and by the next day they can walk already. They can then move to a normal hospital room and the other tubes can be removed around day 2, and can walk freely around the ward by day 3.

In contrast, thoracic surgery is usually performed in the evening. With large incisions, if they wake up too early they will feel pain from those as well, so in some cases, if the surgery was performed in the evening then the tubes can’t be removed until the next day. Recovering from the surgical wounds also takes stamina, and getting up in that condition takes a lot of effort too, so it takes about 12 hours longer to be able to start walking compared to Da Vinci surgery. The fast track differs by about 12 hours, so it takes about a day and a half to be able to walk for 6 minutes without stopping. Given that difference, there is difference of about 4 or 5 days from day 3. That means it takes about twice as long to be discharged from hospital.

In reality, with thoracic surgery it takes about 10 days up to 2 weeks to be discharged, while with Da Vinci surgery it usually takes about 5 days.

What are the risks of Da Vinci surgery?

Just like with cars, if the person controlling it is bad, it can become a tool for killing people. It is now covered by insurance, and the more widespread robot-assisted surgery becomes, the easier it will become for dangerous things to happen.

Robot-assisted surgery can now handle thoracic surgeries that have been performed by top-class Japanese doctors for a long time, not only on the heart, but also for stomach cancer or on the intestines or lungs. I sometimes have the chance to watch those doctors, and they really are skilled. If an unskilled person uses a robot, they won’t get better by using the robot, but the robot can become a “weapon” that refines the surgical skills they have learned so far.

These robots have to be used by a proper doctor. Doctors who control the robots have to be trained to use them safely before they can operate with them, and I think that’s the duty of people like me who have been using them in Japan since the beginning.

Can we hope to see Dr Tokai try robot-assisted surgery later in the drama?

I’m looking forward to seeing how things progress when Dr Tokai uses it. I’m interested to find out how a skilled surgeon like Dr Tokai can bring out the advantages of the robot and perform the techniques that only a robot can perform. Also, robot-assisted surgery is one man surgery, where there are no assistants who can see the operating field, so only one person can control it. Trying to imagine how Dr Tokai will manage to succeed with just his left and right hands and no help from other people is making me anxious.