If the early '90s began to make a fulminant debut in the field of innovation in medicine, with discussions and controversies around the theme of "classical versus minimally invasive surgery," today minimally invasive surgery has established its place and role and finds applications in areas different and in new formulas.
In Romania, in areas such as urology or gynecology, we have been talking about three years of robotic surgery. Robotica made its debut this year in cord surgery as well. Romania seemed to not dream so far, only seven European centers "dare" this new technology.
If we were to give a synthetic definition to the minimally invasive approach, this definition would find its source in the word "invasive". Classical surgery was considered by the traditional school of the time, the path that gave wide opening of the abdomen or the cutting of the sternum, generous gestures and visibility as the eye could encompass. It was all he could offer surgery at that moment.
Over time, these advantages have been outweighed by limits, but especially by the disadvantage of the "invasive" approach and by the impact of the surgical gesture on the quality of life and recovery of the patient.
Passing through classical, vaginal, laparoscopic and hybrid surgery, more than ever, this minimally invasive concept has shown its benefits when robotic intervention, the latest minimally invasive technology. Unlike open surgery where the surgeon, although having good visual access, in deep pelvis areas, has only digital access, in 3D robotic surgery the 3D camera has access to deep pelvis areas, giving the advantage of magnifying the image more than 10 times and giving the surgeon great freedom of movement.
"When you penetrate the tissues offensive, the tissue seems to be the answer, so we tried to get the best of all surgical techniques. Surgical gestures are much safer because in these spaces there are vascular and nerve structures that need to be protected to ensure a good quality of life after surgery, "explains the first gynecologist surgeon who has performed robotic surgery in Romania.
"Classic vs. minimally invasive" in heart attacks
Because in cardiac pathology we are talking about a form of very well-standardized surgery, minimally invasive surgery is practiced in Europe and the United States in an increasing proportion of minimally invasive, but there are still few centers where mitral valve aorta , tricuspid, but also aortic-coronary by-passes to be performed minimally invasively. There are pathologies of excellence dedicated to classical surgery, such as obstructive hypertrophic cardiomyopathy surgery. There is a niche surgery such as mitral valvular pathologies or aortic coronary bypass, for example, reserved for robotic surgery, which has just made its debut in Romania. Only seven European centers have dared this step forward.
From year to year, the number of heart attacks that is currently minimally invasive in the country is increasing. Minimally invasive surgery, unlike the classic approach to sternum cutting, has emerged from the need to reduce trauma, facilitating rapid recovery of the patient. By direct or video-assisted approach, through small incisions of 5-6 cm, the surgeon sneaks and intervenes "microscopically".
Dr. Lucian Dorobanţu, the surgeon who performed many types of heart surgery in South East Europe, explains robotic surgery: "In 2019, we intervene minimally invasively in over 90% of cases for repairing heart valves, repairing coronary lesions, congenital defects . Cardiac surgery is not a "fashion." There is the courage to innovate, but never for the sake of doing it. In a choice between an approach and another, between classical, minimally invasive, robotic, will be the first safe choice for our patient. "
In a dynamic environment, connected to new diagnostic and treatment technologies, to telemedicine devices and platforms already surrounded by robotic technique, surgery is recalibrated according to times: from interventions through minimally invasive or robotic surgery to modulation standards and personalized case approach as less aggressive as possible for the patient.
The offensive of this new approach and personalized medicine was based on the embrace of the holistic concept: to look and treat man before the pathology he suffers. Medicine sought targeted treatments to counteract the drawbacks of traditional surgery, finding "gentler" solutions for patients. Physicians start to look at the uniqueness of the case. The "less in the sea" architectural concept translates into medicine by: "gentler is better for the patient."
Applying the standard to a minimally invasive technique differs, modulates, according to pathology and case. For example, in minimally invasive endometriosis surgery, modulation of standard treatment and finding a personalized therapeutic solution for women suffering from endometriosis are essential.
"In endometriosis surgery, although we are talking about extensive surgery, which is not limited to an organ, but often exceeds the pelvic area, minimally invasive, laparoscopic or robotic surgery, we have the advantage of complete excision of endometriosis lesions with minimal trauma and with the possibility of recovering the patient within a few days of the intervention. In this type of surgery, more than in other pathologies, personalizing the therapeutic solution according to the patient's goals – controlling pain, improving fertility and preventing recurrence – requires a 360 degree look at an entire horizon of factors, all the time in dynamics. Intervention and surgery carefully applied to the tissues, along with the achievement of surgical goals and the need for rapid recovery of the patient, are the keys to the therapeutic process. "Prof. Dr. Evira Bratila.
Transformed from technique into attitude, the minimally invasive approach to surgery has started from the patient's real need to overcome the stages inherent in surgery, as well as the feeling of fear, expectation or non-acceptance of a diagnosis involving a life-threatening intervention . The fear of complex interventions, such as heart surgery or oncological pathologies, had the unjustified delay of something that seemed to be an impossible diagnosis at the mental level.
This is why the minimally invasive interventions have again gained. The benefits of minimally invasive surgery are related to faster recovery, minimization of post-operative complications, reduced blood loss, reduced infection risk, pain control, and limitation of other post-surgical support procedures in intensive care.
The time of hospitalization is very low. The patient can go home in a few days and can resume work as soon as possible after the intervention, which confers an undeniable mental conformation.
If the classic approach has advantages in terms of accessibility and maneuver of surgical gesture, these advantages have been overcome by new techniques. Robotic surgery exceeds the advantages of classical surgery bringing: the precision of the robot-surgeon's gestures, better visibility and access to angles and structures impossible to handle and imagined for the hand, eye, and human mind.
"If we balance the benefits of the process in terms of lack of trauma, complications and psychosomatic impact, the patient only has to win. Minimally Invasive Surgery defines an approach whereby the surgeon must achieve his goal by as few means and gestures as possible, atypical and "gentle". This last term is the word that best defines this form of surgery at the conceptual level, "explains Dr. Dorobanţu.
In medicine, we can not talk about "fashion," but we can certainly talk about trends and innovation. Making the test of time, medicine based on scientific evidence is the only viable alternative. The future undoubtedly belongs to the new technologies and hybrid techniques, which bring together the best practices of all types of surgery, reserved for specific cases. All these techniques encompass the human resource, intelligence and creativity of surgeons who put them into practice. Medicine is a continuous process of learning-innovation. The ultimate goal: Better, gentler, better for the people.