Dr Vassilia Orfanou, PhD, Post Doc
Writes for the Headline Diplomat eMagazine, LUDCI.eu
Introduction
Robotic surgery in Luxembourg started in 2013, with the intention to increase the precision of surgical procedures and ensure a more minimally-invasive surgery. In robot-assisted surgeries, surgeons gain improved access to anatomical regions typically challenging to reach manually. This includes areas like the pelvic cavity in digestive and gynecological procedures, as well as the oropharyngeal space in ENT surgery.
From revolutionizing surgical precision to expediting recovery periods and reducing medical costs, this innovation is transforming the landscape of healthcare delivery nationwide. With over a decade since its introduction, this article discusses the latest advancements in robotic surgery within Luxembourg’s healthcare sector, highlighting its recent successes and widespread adoption.
Luxembourg Hospitals Seeing a Surge in Robotic Surgeries
- Over 1,400 robot-assisted surgical operations have successfully been conducted in Luxembourg with Da Vinci robots as of 2019.
- More than 1,000 surgeries successfully completed with the assistance of robots at the Centre Hospitalier de Luxembourg (CHL) as of 2023.
- 695+ robot-assisted procedures conducted at the department of urology.
- 300+ robot-assisted general surgeries performed annually.
- 395+ robot-assisted orthopedic surgeries performed annually.
Luxembourg Hospitals Embrace Cutting-Edge Robotic Surgery
For more than a decade, hospitals in Luxembourg have been steadfastly integrating robotic-assisted surgery technology into their surgical procedures. This transformative endeavor has required surgeons to reskill to use this cutting-edge tool.
The adoption of robotic surgery represents a significant leap forward in surgical methodologies within Luxembourg, fostering enhanced patient outcomes and ushering in a new era of healthcare delivery across the nation.
Da Vinci Robots Take Center Stage at CHL
The Centre Hospitalier de Luxembourg (CHL) has emerged as a frontrunner in Luxembourg’s robotic surgery landscape. The urology department in the Centre Hospitalier de Luxembourg (CHL) was the first to adopt the Da Vinci robots’+ technology. More than 150 operations have been performed annually since its introduction.
CHL’s commitment to innovation doesn’t stop there. Recognizing the potential of robotics beyond urology, general and orthopedic surgeons at the hospital have been utilising the technology as well. This expansion has yielded impressive results, with these departments now routinely performing over 300 and 395 robotic procedures annually in their respective fields.
Robert Schuman Hospital and MAKO Robots to support surgeries
Beyond the advancements at CHL, another Luxembourg hospital, Robert Schuman Hospital, is actively leveraging the power of robotic surgery. Here, the focus is on the MAKO robotic arm assisted system, specifically designed to aid in knee replacement procedures.
In 2016, orthopedic surgeons at Robert Schumann hospital, Dr Pit Putzeys and Dr Philippe Wilmes started offering knee prosthetics surgery, with the use of robots and on an ambulatory basis.
The 3000th surgical operation assisted by the robot was carried out at Robert Schuman in 2023. According to the hospital, this technology has been allowing surgeons to perform an individually planned, 3D-assisted procedure, based on a patient’s specific diagnosis and anatomy.
“Precision and patient safety are at the forefront of this new surgical technique,” Doctors Putzeys and Wilmes say in a joint statement.
Success Recorded with Robot-assisted Surgical Systems
While robotic surgery adoption has been steadily rising across Luxembourg, the Centre Hospitalier de Luxembourg (CHL) has strengthened its position as a national leader in this field.
CHL records 1,000 Successful Surgeries in 5 Years
Using the Da Vinci Mako robotic system, CHL has successfully performed over 1,000 surgical procedures as of December 2023. This remarkable accomplishment was achieved within a remarkably short timeframe – just five years – since the hospital initiated these procedures in May 2018.
This rapid integration and success highlight CHL’s commitment to cutting-edge technology and its dedication to improving surgical outcomes for patients.
Luxembourg Surpasses 1,400 National Successes
While the focus at CHL has been impressive, it’s important to acknowledge the broader picture of robotic surgery success in Luxembourg.
According to Etienne Schneider, the former Minister of Health, over 1,400 robot-assisted surgical operations were successfully conducted nationwide with Da Vinci robots up to 2019.
Since then, the Da Vinci robot has largely proven itself, gaining the trust of surgeons and marking a major advance in the practice of surgery.
Robotic Surgery Expands Across Key Surgical Key Surgical Disciplines
Returning to CHL’s pioneering efforts, their success extends beyond sheer numbers. They’ve actively expanded the use of robotic surgery beyond its initial application in urology.
Since implementing robotic surgery five years ago, CHL has witnessed a significant increase in its use across various major surgical disciplines. The technology is now routinely incorporated into a wider range of procedures, including:
- General surgery (digestive, visceral, and thoracic)
- Urological surgery
- Gynecological surgery
Advancing Surgical Care using Robotics in Luxembourg
The Da Vinci robot has largely proven itself, gaining the trust of surgeons and advancing the practice of surgery at CHL and other healthcare organizations. Some of the reported benefits include:
Enhanced Precision to advance surgical procedures
Dr. Juan Santiago Azagra, a specialist in general and minimally invasive surgery at CHL, emphasizes the key advantages: “Robot-assisted surgery has allowed us to optimize the surgical procedure more than ever, thanks to the precision and gestural coordination obtained thanks to this extraordinary tool.”
This enhanced precision translates to minimally invasive techniques, allowing surgeons to operate with greater accuracy and control. “In the space of five years, the Da Vinci surgical robot has revolutionized the surgical approach at CHL,” says the specialist.
Working with one of the best enlarged and high-quality 3D vision on the market, the robots operate with a very high-definition operating field. This allows them to carry out more meticulous work and achieve unrivalled precision in the operating procedures.
Reduced Complications and Shorter Stays
A significant reduction in complications is a key advantage of robotic surgery. This benefit is particularly observable in long and highly complex surgeries, where both during and after interventions, the risk of complications is minimized.
For instance, the surgical systems offer surgeons the ability to navigate through complex anatomical structures with high accuracy. This minimizes damage to surrounding tissues, reducing blood loss, and shortening hospital stays.
The integration of HD 3D visualization and microscale instruments has further enhanced the capabilities of robotic surgery, ensuring optimal outcomes for patients.
Positive Experiences in Hip Surgery
The success of robotic surgery extends beyond Luxembourg’s borders. Surgeons like Professor Alister Hart, a consultant hip orthopaedic surgeon, have reported positive experiences with robotic hip surgery in Luxembourg.
During a training visit to the Mako Lab in December 2019, Professor Hart observed improved accuracy in cup placement using robotic assistance. He noted a successful case, where the robot precisely achieved the planned under-reaming of 1mm. Depending on the implant type, robotic surgery also offers the potential for minimally invasive techniques.
“I have just returned from learning robotic hip surgery at the Mako Lab in the Centre hospitalier Kirchberg, Luxembourg, hosted by Dr. Pierre Putzeys. It was a fantastic experience,’’ comments Professor Hart on LinkedIn. “Maybe we were lucky with the first case? So, we tried another case, and achieved the same perfect result.”
Faster Recovery and Potential Cost Benefits
The robot-assisted technique allows surgeons to undertake more complicated surgeries that are more comfortable for patients and cost-friendly for the National Health Fund (NHF).
Notably, the cost-to-patients are lower or, worse, remain the same for robotic-assisted surgery compared to traditional methods. Admittedly, the Da Vinci robots used in Luxembourg – which are some of the most advanced robotic surgery technologies in the world – cost €2.2m each as of 2019, according to RTL Today.
So, it increases the cost of surgical operations on an hourly basis. But the increase in surgical operation costs may reduce thanks to the lower admission hours and quicker recovery times. After all, the technology is less-invasive and patients can be discharged the same day.
Additional Robotics Benefits
Robot-assisted laparoscopies, according to Current Urology, are also effective in many areas and notably achieve the following effects:
- Reduction of postoperative pain in urology surgery
- Earlier resumption of bowel function
- Faster return to normal activity
- Less pain related to healing of the abdominal wall
- Decreased amount of bleeding and less visible scars
Minimally Invasive Surgical Techniques
The shift towards minimally invasive surgical techniques in Luxembourg has been instrumental in improving patient care. Surgery has traditionally involved performing invasive procedures to treat various diseases. These procedures involved making a large incision in the wall, which was necessary but caused trauma to the patient.
In recent decades, thanks to the invention of digital imaging technology, combined with optical engineering and improvements in video displays, surgeons can operate inside body cavities without the need to perform large incisions on the skin.
Rather than creating large incisions several centimetres long, minimally-invasive surgical techniques generally rely on incisionless surgery (endoscopic resection surgery, which is performed through the urinary tract) or small incisions of 5 to 10 mm to insert instruments.
In urology, it is now possible to treat most diseases with a minimally invasive approach.
There are different minimally invasive surgical techniques depending on the diseases to be treated.
- Traditional Laparoscopy: They consist of making small incisions to insert a micro-camera, as well as small instruments into the stomach. This is a type of keyhole surgery used to remove organs, repair hernias, remove the womb or fibroid.
- Robot-assisted laparoscopy: Laparoscopic machine-assisted surgeries with robots like DaVinci models are used for the operation of heart surgeries, urological cancers, gynecologic surgeries, and prostate, kidney, and bladder cancer.
Contribution of Robotics to Minimally-invasive Surgeries
Surgical robots are instruments with arms, cameras, and platforms that surgeons manipulate using controls. While they cannot perform tasks entirely on their own in humans, they provide significant assistance during minimally invasive surgery.
One major benefit is improved camera control. In traditional laparoscopy, holding the camera for hours can cause hand fatigue and shaky movements, potentially affecting the surgeon’s view. Robotic systems, such as optical door robots, can hold the camera steady, allowing the surgeon to focus on the procedure.
The Da Vinci robot takes robotic assistance a step further. It holds the surgical instruments as well, allowing the surgeon to operate remotely while seated comfortably in a console. This offers several advantages:
- 3D vision: The system provides a magnified 3D view of the surgical field, enhancing depth perception and precision.
- Improved dexterity: The robotic arms have greater articulation than the human wrist, allowing for more intricate movements during surgery.
The Da Vinci robot is particularly valuable for complex procedures requiring high precision, such as radical prostatectomy, partial nephrectomy for small kidney tumors, and repair of congenital malformations like pyeloureteral junction obstruction.
Collaborations Driving Technological Advancements
The impressive advancements in Luxembourg’s robotic surgery landscape aren’t solely attributable to adopting innovative technologies. A critical factor has been the strong network of collaboration between healthcare providers, academic institutions, and technology companies. An example is the partnership between the Luxembourg Institute of Health and Catalpa Ventures for innovation in digital health.
These partnerships have played a crucial role in advancing the field of robotic surgery by fostering research, training programs, and the development of state-of-the-art surgical systems.
By working together, stakeholders in Luxembourg’s healthcare sector have been able to push the boundaries of surgical innovation and ensure that patients receive the best possible care.
To accommodate the new technology, more surgeons are reported to have been trained in this technology. The first year of adoption of this technology at the CHL saw over 15 surgeons trained to operate the robots, according to Delano. While more have been reported to be going on training, there are no official figures on the numbers in recent times.
Nonetheless, the investment in surgeon training is evident and ensures continued growth and expertise in robotic surgery.
Robotic surgery improves healthcare practices
The integration of robotic surgery systems and minimally invasive procedures in Luxembourg hospitals is a significant leap forward in modern healthcare practices. Healthcare providers in Luxembourg are enhancing surgical precision, improving patient outcomes, and setting new standards for quality care with the power of Robotic technology. Through collaborative efforts, the future of robotic surgery in Luxembourg looks promising. Continued advancements are expected to further elevate the standard of surgical care in the country. This will ultimately benefit patients with safer, more precise, and efficient surgical interventions.
Empowering Patients in Luxembourg’s Surgical Landscape
For patients in Luxembourg, it is essential to stay informed about the latest advancements in surgical technologies and procedures available in healthcare facilities. If you or a loved one are facing a surgical intervention, consider discussing the possibility of robotic surgery or minimally invasive procedures with your healthcare provider. Stay proactive in exploring options that can potentially lead to quicker recovery times, reduced risks, and improved outcomes.
References
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Photo from Pavel Danilyuk: https://www.pexels.com/el-gr/photo/8438979/
