ByMAAYAN JAFFE-HOFFMAN
A doctor at the Rabin Medical Center-Beilinson Campus, Petah Tikva, has used – for the first time in Israel – a da Vinci robot to perform the complex surgery of untrapping a man’s ureter from behind his vena cava – the largest vein in the body which carries blood to the heart from other areas.

Last month, a 41-year-old patient checked in to Beilinson suffering from the effects of a retrocaval ureter, a ureter that abnormally encircles the inferior vena cava. Only one in 1,500 people are born with this deformity, which worsens over decades until it eventually leads to sepsis.

A retrocaval ureter passes behind the large vein instead of in front of or next to it. The only way to cure the person is to perform a complex operation to move the ureter.

Usually, “open” surgery is performed, meaning the patient is cut open. But Dr. Shay Golan, head of the Urologic Oncology Service at Beilinson, decided to try something new, and, for the first time in Israel, a robot performed the surgery, in 50 minutes, making only three very small incisions (each less than a centimeter) in his belly and without any blood loss.

“He is a young, healthy guy, so he recovered very quickly,” Golan told The Jerusalem Post. “A day after the surgery, he was able to perform all the basic things by himself – like taking a shower, walking by himself, eating what he wanted without limitations. After three days in the hospital, we discharged him.”

In contrast, the doctor said, if the surgery had been performed the usual way, the patient would have been in much more pain, and there would have been a much higher risk for complications, since a 15- to 20-centimeter incision would have been made, increasing the chances for wound infection.

Pain medications would have kept him in the hospital longer, and his recovery would likely have taken much more time.

The da Vinci robotic surgical system has been around for decades. The same surgery has been performed in other countries, though not many times. This was the first time that any hospital in Israel tried to do it.

The surgeon sits on a console that can theoretically be far away from the surgical bed, though in practice, he or she is in the room and communicating with the nurses and assistants who are standing by the patient.

The surgeon uses two joysticks to manipulate the robotic hands.

“The surgeon is in full control,” Golan stressed. “The robot does nothing autonomously.”

The robot has four hands: three that can “do the work” and one that holds a camera. The pictures that the camera-hand captures are displayed on a large video screen, allowing the surgeon to see what is going on inside the patient.

“You see everything 12 times better because the robotic system’s camera gives you 3D vision, making the precision better, which translates perfectly and directly into improved clinical outcomes,” Golan said.

Using robots to perform such surgeries is just “one of the new developments we can expect to see in the coming years,” he said.