2023-05-19 08:16:33
In plastic surgery, specialists from the LMU Klinikum have used a surgical robot for the first time – the surgical premiere was a success. Other cancer patients should benefit from the technology.
The patient swallowed hard when he found out about the doctors’ plan: They had to remove a huge soft tissue tumor on the back of his head, this so-called sarcoma measuring around 15 by 15 centimetres. In order to close the hole in the tissue again afterwards, the plastic surgeons at the LMU Klinikum transplanted a back muscle onto his head. More specifically, the latissimus. “It’s the largest muscle in the body. Everyone has two of them, they run to the left and right of the spine,” explains associate professor Dr. Denis Ehrl (40), deputy director of the department.
With conventional surgery, a 40 centimeter long skin incision is necessary
What sounds almost scary for laypeople is standard for experts like Ehrl. The strategy of using the lats to cover defects, as the lingo calls it, has been around for decades. For two main reasons: On the one hand, you can live with only one of these two back muscles without major restrictions, on the other hand, it is ideal for transplantation. “It is essentially only supplied with blood by one main vessel, which means it can be separated from the vascular system and reattached relatively easily,” explains Ehrl. However, in a conventional operation, the specialists have to make a skin incision about 40 centimeters long in order to remove the muscles.
Robot enables surgery with much smaller incisions
With the help of the robot, the plastic surgeons were able to spare their patient this giant incision. Instead, they now had two small openings, about one centimeter long, to insert the robotic arms into the body, and an opening about six centimeters long to “recover” the muscle. “The smaller cuts make a huge difference. As a result, the removal of the muscle is much gentler on the patient and healing is accelerated,” reports Ehrl.
Operator Ehrl controls the filigree robotic arms with joysticks
During the robotic operation, its filigree and flexible arms work practically under the skin. They are controlled by the surgeon with joysticks, while he is sitting several meters away from the operating table and staring intently at a monitor. His assistants stand directly next to the patient and monitor the procedure. The decisive factor here is that the robot does not make a hand stroke on its own, the doctor is master of the procedure at all times.
The Da Vinci robotic system has already proven itself in other medical fields
For the OP premiere in plastic surgery, the LMU specialists used the established Da Vinci robot system. It has already proven itself in other medical fields for many years and has been technically refined over the years. “Originally, Da Vinci was developed for heart surgeries. But many patients are familiar with it from urology and visceral surgery, where it is used very successfully for operations on the prostate or intestines, among other things,” reports Professor Konrad Karcz, head of the “Minimally Invasive Surgery/ Surgical Technological Innovations” working group. at the LMU Clinic. The intensive preparation was also made possible thanks to the support of the two heads of plastic surgery and urology, Prof. Riccardo Giunta and Prof. Christian Stief.
Robot specialist Karcz as coach
Because abdominal surgeon Karcz (50) has a lot of experience with the Da Vinci robot, he practically supported his colleague Ehrl as a coach. Before the premiere of the surgery, the plastic surgeon spent hours training in simulations for each individual work step. In the case of his cancer patient Mirbagir, Ehrl was also supported by colleagues from neurosurgery. Because the tumor had grown into the skullcap, they had to remove part and replace it with artificial bone.
Patient (64) from Ukraine has been battling cancer for 25 years
Despite the great exertion, the patient recovered surprisingly quickly. Just a few days after the operation, the 64-year-old Ukrainian was allowed to leave the hospital after just a few days, and only a few weeks later the wound healing process was progressing well. “I’ve been fighting this cancer for 25 years, and I’ve had multiple surgeries. But lately the tumor had grown a lot. I’m glad that it could be removed so easily and I’m grateful to the great doctors at the LMU Klinikum for my new life,” says Mirbagir.
Nephew reports: “His eyes are sparkling again, they are full of life”
The whole family is overjoyed that the 64-year-old is doing well again – especially since she recently had to cope with a severe stroke of fate. Mirbagir’s son died of a heart attack at the age of just 35, and his father’s three other children and six grandchildren are also married. Mirbagir’s successful treatment has brought some light back into the family’s everyday life. “The little ones in particular are happy that they have their grandfather back and can play with him,” reports Mirbagir’s nephew Ramil (35). “Despite our sadness for my cousin, we are all delighted to have him back with us. When he romps around with his grandchildren, you can see a twinkle in his eyes again. You are full of life.”
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