High-precision robotics in the hands of a specialist: Prof. Dr Robert Rosenberg is one of the leading surgeons using the robot-assisted Da Vinci surgical system. Robotic technology, which has long been standard practice in prostate surgery, is also increasingly being used in abdominal surgery. The Head of Visceral Surgery at the Cantonal Hospital of Basel, who enjoys an international reputation as a proven specialist at the Liestal site, is also responsible for this trend. In an interview with the Leading Medicine Guide, he explains exactly what sets this state-of-the-art surgical technology apart. Furthermore, the experienced high-performance clinician discusses the prognosis for recovery following robot-assisted surgery.
Leading Medicine Guide: What exactly sets Da Vinci robotic technology apart from conventional surgical methods?
Prof. Dr Robert Rosenberg: The truly remarkable thing about this technology is the robot’s precision, which a human hand cannot match. The robot is equipped with four arms, on which various instruments are mounted – including a camera. These arms are controlled from an external console using a joystick. So I am still the one performing the surgery as the surgeon, not the robot. It’s just that I can sit in front of the screen instead of standing at the operating table. Another special feature of the robotic arms is that they are much more flexible than the human hand. This makes it possible to rotate them up to 360 degrees, allowing for highly precise incisions and procedures to be carried out in the tightest of spaces. What’s more, the camera projects a crystal-clear image of the abdominal cavity, magnified tenfold, onto the console screen. The robot is a fantastic system that supports and facilitates surgical work.
Leading Medicine Guide: What an innovation! How has this technology developed historically?
Prof. Dr Robert Rosenberg: It was urology that historically made this technology great. Today, it is impossible to imagine prostate surgery without the robot; it is now considered the standard. This is because the precise dissection allows nerve fibers to be spared, at least according to the prevailing scientific opinion. Over the years, the robot has also been used increasingly in gynecology and abdominal surgery.
Leading Medicine Guide: And what happened next?
Prof. Dr Robert Rosenberg: The technology has been continuously optimized and further developed. Before that, abdominal surgery was more difficult. Imagine it like this: during bowel surgery, we have to work our way from the upper left abdomen down to the lower left abdomen and into the pelvis. This requires a great deal of movement of the robotic arms. In the meantime, the robotic arms have become increasingly slender, and their mobility has improved enormously. This means that with the Da Vinci robot, we also have an excellent tool for abdominal surgery. And not just here in Basel: abdominal surgical procedures using robotic technology are being performed more and more worldwide.
Leading Medicine Guide: What is the situation at your clinic?
Prof. Dr Robert Rosenberg: We have been using the robot for five years now. We are currently switching to the latest model and are performing around a hundred robotic operations a year. These are mainly bowel and hernia operations, or diaphragmatic hernias. These are the three main areas at the moment – and the results are all very good.
Leading Medicine Guide: Do you sometimes encounter resistance from patients who have reservations about being operated on by a robot?
Prof. Dr Robert Rosenberg: Interestingly, that is not the case at all. There are a few patients who ask about it themselves, but that is probably more to do with the fact that the surgical method is not very well known. When we explain the method during the consultation, those affected are immediately very interested. Fortunately, we haven’t had any negative experiences with the robotic system so far, so we can definitely recommend it.
Leading Medicine Guide: The robot’s slimmer arms and a more minimally invasive surgical method also improve the prognosis for recovery, don’t they?
Prof. Dr Robert Rosenberg: Yes, that is the theory and my belief. However, it is very difficult to measure this conclusively. It is clear that the minimally invasive procedure alone is much gentler than a large abdominal incision. The advantages of robotic technology – compared to minimally invasive or laparoscopic surgery – are the better overview and simplified access. Suturing is also significantly easier with the robot. However, scientific studies have not yet been able to prove that there is a significantly improved prognosis for recovery through the use of robotic technology. We do, however, have the impression that patients who have been operated on using the Da Vinci robot recover a little more quickly. That said, the differences cannot yet be measured scientifically, especially as we are already achieving excellent results with conventional minimally invasive techniques.
Leading Medicine Guide: What is it like to be directly involved in such significant innovations in high-performance medicine?
Prof. Dr Robert Rosenberg: For me, as a consultant at a large cantonal hospital, it is important that we surgeons can participate in these innovations and that we continue to develop alongside the latest technologies. This benefits our patients, who gain from the fact that we are at the cutting edge of medical knowledge. After all, robotic systems will continue to evolve steadily in the coming years and become increasingly prevalent in medicine.
Leading Medicine Guide: Are there any other innovations in the field of colorectal surgery that are already being incorporated into your practice?
Prof. Dr Robert Rosenberg: What is excellent and has further improved our results is the innovative assessment of anastomotic blood flow using a fluorescent dye during the operation. It works as follows: when you remove a section of the bowel, the two ends of the bowel must be securely joined together so that bowel function is restored. To achieve this, a so-called anastomosis is performed, i.e. a bowel connection. Here, care must be taken to ensure that blood flow is maintained right down to the very tips.
Leading Medicine Guide: And how should we picture that?
Prof. Dr Robert Rosenberg: For several years now, we have been using the PINPOINT method: this is a device that uses a fluorescent dye, namely ICG, which stands for indocyanine green. So, if I have two ends of the intestine that I want to connect, the anesthesiologist injects ICG intravenously. We dim the lights in the room and use a special laser camera. This allows us to see where the bowel turns green. And if the color is missing in certain areas, I know that I still need to remove a section there. This application has significantly improved outcomes in bowel surgery in recent years.
Leading Medicine Guide: Thank you very much for the fascinating and insightful conversation, Prof. Dr Rosenberg!
Prof. Dr Robert Rosenberg FACS, EMBA is a highly specialized tumor and visceral surgeon who, as Head of Visceral Surgery, also heads the renowned Colorectal Cancer Center at the Cantonal Hospital in Basel. As a certified senior colorectal surgeon, he enjoys an international reputation for his outstanding diagnostic and therapeutic expertise. The surgical team in Liestal offers the full spectrum of visceral surgery using open, laparoscopic – i.e. minimally invasive keyhole techniques – and robot-assisted surgical techniques. You can find out more about the Baselland Cantonal Hospital, Liestal site, and Professor Dr Robert Rosenberg on the profile page in the Leading Medicine Guide.
