As a renowned specialist in the field of abdominal wall and hernia surgery, Senior Physician Dr. med. univ. Teodor Kapitanov, FEBS – AWS, is highly regarded both nationally and internationally. As a board-certified specialist in general surgery and visceral surgery in Austria and Switzerland, he has established himself in recent years as one of the leading experts, particularly in the use of the state-of-the-art da Vinci® robotic system, thanks to his great dedication and countless successful procedures. Dr. Kapitanov works as a senior physician at the Floridsdorf Clinic in Vienna, where, among other responsibilities, he heads the hernia outpatient clinic, which specializes in complex cases.
In today’s expert interview, Dr. Teodor Kapitanov spoke with the editorial team at Leading Medicine Guide about the latest developments in the field of robot-assisted hernia surgery and provided insights into his newest project, the startup SurgVRse, a VR e-learning platform.
In recent decades, medicine has made remarkable progress, particularly in surgery, where innovative technologies are continuously improving treatment outcomes and enhancing patient safety. One particularly fascinating area is hernia surgery, which has been revolutionized by the introduction of robot-assisted procedures.
Robot-assisted surgery has also evolved significantly in the field of hernia surgery and represents a major advance over traditional methods.
“Robotic surgery today faces similar challenges and limitations to those faced by laparoscopy over 30 years ago. However, the advantages of this innovative technology have already been amply demonstrated, making it an indispensable part of everyday surgical practice. Robot-assisted hernia surgery, however, is still in its early stages of development; it should be noted, however, that the results of robot-assisted hernia surgery are in no way inferior to those of conventional laparoscopic procedures. On the contrary—robotics not only expands the boundaries of minimally invasive possibilities but is also associated with remarkably low morbidity and exceptionally good outcomes—particularly with regard to the extraperitoneal placement of synthetic meshes. “There has been a significant increase in robot-assisted procedures worldwide in the field of abdominal wall and hernia surgery,” explains Dr. Kapitanov at the start of our conversation, adding: “The shorter postoperative recovery time and lower complication rate, as demonstrated by numerous studies, are clearly observable following my robotic procedures. Reconstructive hernia surgery benefits enormously from more precise surgical techniques, which the system enables through its three-dimensional capabilities and tenfold magnification of the surgical field.”
The introduction of robot-assisted techniques in hernia surgery presents some challenges. Before robotic systems can be used, the surgeon must first undergo an intensive training period.
“As with any implementation of new technology, a certain training period is a prerequisite for robot-assisted surgery—this is referred to as the ‘learning curve.’ This must be clearly distinguished from the higher complication rates once associated with the introductory phases of new surgical procedures. Rather, it involves the surgeon becoming accustomed to the technology and gradually familiarizing themselves with the numerous surgical possibilities and limitations of robotics. The learning curve can vary depending on the surgeon’s prior experience in the field of minimally invasive surgery. Some robot-assisted procedures in hernia surgery take longer than others. For example, r-ventral TAPP typically takes significantly less time—with a console time of approximately 44 minutes—than r-TAR, which averages 188 minutes; however, these are average times that decrease significantly with increasing experience. Recent studies show that a reduction in the required operative time begins to occur after approximately 40 cases. Training on a simulator—which consists of basic skills training and virtually guided surgeries—as well as dry-lab and wet-lab training on phantom and cadaver models is essential for the safe implementation of a robotic program. To further optimize team building and patient safety, non-technical skills—such as proper phrasing and command language—should also be integrated as part of behavioral training. Although robotic surgery offers the surgeon a high degree of autonomy, collaboration with a well-trained surgical team is essential. Ideally, the core team consists of members who possess diverse expertise due to their varying levels of experience. Ultimately, this mix of expertise within the core team will be the key to success when implementing a robotic program,” explains Dr. Kapitanov, adding:
“Equally important—and not to be underestimated—is the personal exchange of experiences with proctors, whether through in-person observations or, optionally, virtual sessions, as well as an interest in international digital platforms and online courses followed by knowledge tests.”
The VR e-learning platform SurgVRse is an innovative learning environment designed to enhance surgical training using virtual reality (VR).
“The VR e-learning platform SurgVRse is a virtual reality e-learning and training platform for robot-assisted, immersive surgical instruction. The name is a combination of the words ‘surgery’ (German: Chirurgie) and VR (Virtual Reality), as well as the metaverse (German: Metaversum), a concept in which a digital space is created through the interaction of virtual, augmented, and physical reality. Our company, consisting of Michael Maier, an engineer with a master’s degree, a long-time consultant in the digital and innovation sectors with a strong focus on sales and marketing as well as relevant leadership experience, and myself, was founded with the vision of revolutionizing training in the field of robot-assisted surgery. We recognized that traditional teaching methods, such as conventional textbooks or 2D video formats, are insufficient to convey the complexity and realism of a robot-assisted surgery. Therefore, we decided to harness the power of virtual reality technology to translate the essence of three-dimensionality and the precision of the degrees of freedom of instruments in robot-assisted procedures into a corresponding immersive and realistic learning experience. “In summary, SurgVRse is a complementary innovation in the field of robotic surgery that is intended to make a significant contribution to more accessible and efficient training for surgical residents and future surgeons,” explains Dr. Kapitanov.
The use of VR technology can accelerate the preoperative planning and execution of hernia surgeries compared to conventional training methods.
“Various studies have shown that people can absorb and process immersive 3D content four times faster. Surgeons can thus prepare for their upcoming task as realistically as possible—much like Formula 1 drivers during a ‘warm-up’—at any time, 24/7,” emphasizes Dr. Kapitanov.
SurgVRse offers a range of specific functions and features designed to optimize the learning process for aspiring surgeons and support hands-on surgical practice. These features are designed to provide comprehensive and practical training that integrates seamlessly with real-world surgical requirements.
“The core element is clearly the combination of unique video footage—curated by a highly qualified, growing team of robot-specialized surgeons, and didactically structured simulation units, which are implemented using state-of-the-art VR technology in 3D video and audio formats. This allows our users to significantly shorten their learning curve in robotic surgery and more quickly acquire the necessary skills to safely integrate these technologies into their daily practice. In addition, we offer not only standardized content but also customized solutions for hospitals and medical training centers that wish to train their staff in robotic surgery. In the future, we will integrate features to improve and further develop the user journey using AI assistance. “Based on our experts’ know-how, the videos can be equipped with an AI assistant that can address individual questions and issues directly while the video is being watched,” emphasizes Dr. Kapitanov.
The future still has a lot in store.
“Robot-assisted surgery is becoming increasingly important. Worldwide, the total number of surgeons trained on the da Vinci® system reached 76,000 in 2023. At the same time, virtual reality technology has already proven to be an effective tool for improving medical education. The market for VR e-learning platforms in the medical industry is growing steadily. This growth is driven by the rising demand for more effective and realistic training methods in the medical industry. Due to globalization and digitalization, the demand for medical training content that is accessible online and globally 24/7 is increasing. Our platform enables us to reach customers in various countries and provide them with high-quality, up-to-date training content. While the outdated “see one, do one, teach one” method was often promoted in the past, the mindset in surgical specialties is increasingly shifting toward a modern training culture. “After all, the surgeon’s learning curve must not become the patient’s suffering curve,” emphasizes Dr. Kapitanov, and with that, we conclude our conversation.
Thank you very much, Dr. Kapitanov, for this in-depth look at innovative robotic surgery. SurgVRse is sure to make a big splash!
