The performance of bariatric surgery at Hospital Vila Santa Catarina, in the south zone, earlier this month, became a milestone in the capital of São Paulo. It was the first to be carried out by a robot, equipment that becomes part of the high complexity structure of this municipal hospital unit.
The equipment was donated by the Sociedade Beneficente Israelita Brasileira Albert Einstein, which runs the entire management of the municipal hospital. The robot is installed at the Bruno Covas High Tech Center for Oncological Diagnosis and Intervention, inaugurated this Monday (16) inside the hospital in the south zone. The cost of the device is approximately R$ 7 million.
The objective, according to the management, is to apply robotic technology in oncological surgeries, such as cancer of the ovary, intestine, colon, liver, pancreas and rectum, and other specialties to expand the benefits of the method to patients in the public health system.
“Santa Catarina is one of the few municipal hospitals dedicated to high complexity, such as oncology care and high-risk childbirth. Within the oncology specialty, the advent of the robot becomes something very advantageous for the outcome of some surgeries that are already known today and has robust scientific evidence”, says Sidney Klajner, digestive system surgeon and president of Einstein.
The first patient to be operated on by the robot was a 42-year-old woman with grade 2 obesity — when the BMI is between 35 and 39.9 (above 40 is considered severe obesity) — and comorbidities such as diabetes and hypertension.
Klajner manipulated the robot through a console, altering the path of food in the digestive tract, decreasing the storage capacity and absorption of calories. The surgery lasted one hour and 20 minutes.
In the procedure, the operation is assisted by robots using a minimally invasive technique, in which the maneuvers are conducted by the surgeon and performed by means of the robot, with movement control made through joysticks.
“In the robot, the natural tremor of the hand is filtered out, the articulation of the clamps is even better than the surgeon’s wrist, which in laparoscopy only moves in two directions, sideways or upwards”, explains the surgeon.
According to the doctor, surgery with a robot is not necessarily a reduction in surgical time. The start of a laparoscopy surgery is shorter than getting the robot up and running to begin with. “Perhaps, in the sum of time, it does not bring an advantage with a greater speed. But certainly a sophistication of movement and a detail in the visualization, brings a better efficiency”, explains the doctor.
“The operative trauma can be much smaller, as well as the level of bleeding. The patient who underwent bariatric surgery was discharged the day after her surgery. She was hospitalized for less than 48 hours.”
The relationship between Einstein and the City of São Paulo with Hospital Vila Santa Catarina works in the form of an agreement. The professionals who work there are hired by Einstein to work exclusively in this hospital that serves the SUS.
To operate the robot, the team underwent training at the central unit of the private hospital, in the Morumbi neighborhood, in the west zone. On site, there is a platform with 12 robots, three of them for training. According to Klajner, Einstein invested BRL 46 million between 2008 and 2018 in the robotic platform.
According to Luiz Carlos Zamarco, municipal secretary of health, the city hall “has invested a lot in this hospital to be a reference in oncology”. “High complexity is for the state, but as we have 12.5 million inhabitants in the city and a great demand, it is a partnership that we are making with the state to also help in this service in the municipality.”
“The population benefits from excellent treatment in an area where it is perhaps the greatest challenge facing humanity. A huge number of patients will still develop cancer because of longevity”, says the Einstein manager.
Queue of 600 thousand people in the state and difficult cost for SUS
On the 9th of this month, Governor Rodrigo Garcia (PSDB) said that the state has a queue of approximately 600,000 people waiting for surgery. The volume grew during the pandemic. For surgeon Sidney Klajner, early identification of the tumor is essential to combat this demand.
“While waiting for an appointment, patients end up missing what we call ‘golden time’, the golden hour, where the treatment ends up having better results and much lower cost.”
For Fiocruz Brasília public health researcher Flávia Tavares Silva Elias, PhD in technology assessment and health programs, technological advancement is always useful, but it is necessary to consider the financial feasibility so that it can reach society more easily.
“It’s a useful innovation, but you have to think about the cost and effectiveness of this for the public sector. We already have difficulty having the usual laparoscopy surgery in the SUS because of the price of tweezers”, says Flávia.
In addition, according to the researcher, the surgeon must learn to use robotics. “It’s not just about whether it works. It’s about the cost, compared to something that’s already built in.”
Flávia also understands that there is a delay in technological innovation in the country due to the lack of investments in the sector.
“There is a huge discrepancy between the public and private systems. The science and technology policy in Brazil has had an immeasurable loss of resources. With that, I don’t see a prospect of Brazil being that innovative. If it were, it would be investing in country’s own developmental research.”
Chad-98Weaver, a distinguished author at NewsBulletin247, excels in the craft of article writing. With a keen eye for detail and a penchant for storytelling, Chad delivers informative and engaging content that resonates with readers across various subjects. His contributions are a testament to his dedication and expertise in the field of journalism.
