Nov, 30 -0001

The First Robotic Surgery Training Program in Turkey

Ege University Faculty of Medicine has crowned its experience in laparoscopy surgeries by putting the Robotic Surgery Unit "EGE1" into service. EÜ Faculty of Medicine Faculty Members Prof.Dr. Fatih Şendağ, Prof.Dr. Erdal Apaydın, Prof.Dr. Patients and surgeons will benefit from many advantages in surgeries with the EGE1, which was brought to the hospital as a result of a four-year study conducted by Sinan Ersin.
Pointing out that it is good, but not sufficient, to bring a state-of-the-art device to the hospital, EÜ Gynecology and Obstetrics Department Lecturer Prof. Dr. Fatih Sendag; He gave the good news that they will implement the "Robotic Surgery Training Program" for the first time in Turkey with investments in the field of knowledge and technological infrastructure. Also carrying out the Presidency of the Gynecological Endoscopy Association, Prof.Dr. We talked to Şendağ about the determination of Ege University to be not only a regional but a national education and technology base. Prof. dr. Şendağ said that Ege University, which is preparing to train the robotic surgeons of the future, will soon implement many firsts in this field.
"The future of robotic surgery"
How did the efforts to bring the Robotic Surgery Unit to Ege University started? Can you talk about this process?

We started the preparations for the robotic surgery unit about 4 years ago. Prof. from the urology clinic as 3 main disciplines. Dr. Erdal Apaydın, from the general surgery clinic, Prof. Dr. Sinan Ersin and I, our Rector Prof.Dr. We went to meet with Can Değer Yılmaz, we said that endoscopic surgery in Turkey is now slowly moving towards robotic surgery, that there are developments in Turkey in this sense and that we want to prepare a project, thinking that we should not stay out of this. Our rector welcomed this idea very positively. But of course this requires a serious investment. Covering this cost etc. The process took up to 4 years. Later, a commission was established and the process has come to this day. Why did we start this, why did we bring this project to the agenda? Because we know that technology is developing very fast and the future is robotic surgery, this is an inevitable process. It may seem extreme right now, but we know that in the future, it will actually appear as a perfectly normal surgery. This is a very advanced, very advanced technology, which is considered as space technology. And why should Ege University be excluded from this technology? Why not Ege University, which has achieved many firsts? We set out with this idea, we struggled a lot and tried to express our ideas. After all, our rector was very open to these issues and supported us a lot.
Firsts in the world and in Turkey
Ege University Faculty of Medicine is an institution that gives importance to surgeon education. Can you talk about these training processes?

In 2002, we started training in the field of gynecological endoscopic surgery, we made live broadcasts, and there were participations from abroad to these broadcasts. We then continued these publications in 2005, 2008 and 2010. And now we will do the fifth of these publications in April 1921. Of course, we have started a separate training program since 2008. This program was also a one-month program that included only 5 obstetricians. Participation from all of Turkey is provided. We only accept 5 people per program, they stay with us for 1 month. He receives one-on-one training both in our laboratory and in the operating room, and there is currently no example of such a training program in the world. Usually the programs are 3 days 5 days 1 week course you go abroad. But it does not have a 1-month-only endoscopy focused and intensive program. A world-renowned surgeon attends every program as our guest. Dr. from Germany to our program we organized in March. Sara Brucker joined. He is now the European general secretary of endoscopy, and together with him we developed a new technique called neovagina. This is one of the firsts in Turkey.
We have been implementing the 13th program since 2008, we have trained 65 obstetricians in Turkey. This is an important number. We are currently the only institution providing training on gynecological endoscopy. All the obstetricians we have trained are all over Turkey and they are starting to apply closed surgical techniques to their patients. So we are actually growing exponentially. You throw a stone and I think there is an effect like the waves forming in the sea. We are a university serving Turkey, training physicians.
We are an experienced institution that does this job best in Turkey, and can make publications in America and Europe with congresses. We also have all kinds of technological infrastructure that can transfer the meeting here to Istanbul, so why don't we have a robot and this is why robotic surgery has come to the fore.
What kind of surgeries will Robotic Surgery be used in? Can it be used in all operations performed by surgeons?
We have successfully performed 7 surgeries so far. Of course, there is the question of what kind of surgery the robot will be used in. It can be used in general in urology, general surgery and gynecology. From our point of view, everything that is done with the closed surgery technique can be done with a robot. The only thing that changes here is that we do the surgery by remotely controlling the robot's arms. So we do not touch the patient. We are not with the patient. We sit in a chair in the operating room and perform the surgery. While performing the surgery, you perform very millimetric movements with great skill. The robot imitates the movements of the wrist, the movements of your fingers. It can do 540 degrees of wrist movement. You can move it at different angles in 7 planes. No shaking is one of its most important features. You can enlarge the field of view, you can get as close as you want, you can see in three dimensions in real terms, it is as if you are in surgery. These naturally increase the feasibility of a surgery. It is much easier and better to suture during surgery with the robot. Apart from that, removing some fibroids and repairing the uterus may give better results when done with a robot. If you cannot use the robot successfully, if you do not have a foundation and infrastructure and you start directly with the robot, this may cause some problems. Therefore, our recommendation is that robots should be started after a serious surgical experience. Our luck is that we have very good surgeons in various branches in various clinics in our hospital.
Do you have any plans to implement a program related to the training of surgeons within the body of Ege University in the future?
Of course, we already have a training program and as I said, this is the only training program in Turkey, and we want to add robots to this training program. We will probably start robotic surgery training towards the end of May. Our infrastructure work for this training is ready, we have now added the robotic simulation device to our structure. In terms of education, simulations are very important. This device is currently not available anywhere in Turkey. Afterwards, we will take a step forward in education with a console we call the second console. This will be mounted on Ege 1, and the person who will receive training will sit on that console. The more you allow on your own console, the more authorized the trainee on the other console will be and you will control his movements. You will sit across from each other, he will be on a console, you will be on a console. While operating the patient, you can restrict his movements by telling him to come here, hold there, stop there. Therefore, you control everything so that the patient does not take risks.
"EU will establish the system, learn and teach"
There are other institutions that have switched to the robotic surgery system. What will be the difference of Ege University in applying this system?

Yes, after all, this robot is the 16th robot in Turkey. So we are not the first to do this. Our claim as Ege University is to be the center that uses the robot best. The difference of Aegean will be as follows; Ege will not be a university that just takes a system and uses it within its own body, it will establish, learn and teach a system. Therefore, our motto should be "The Aegean is Teaching", that is, the Aegean has such a mission, Aegean has taught and is teaching a lot of things. Therefore, this will be our difference in robotic surgery. As in everything else, Ege will share, train and teach the robot. Thus, physicians who know new robotic surgery will be formed. This is the goal that our esteemed rector wants us to achieve as quickly as possible and set before us:
"The EU is teaching!"
What kind of advantage will Robotic Surgery provide to Ege University and physicians?

Having a robot will definitely make us a center of attraction. Of course, the Ministry of Health also needs support in this regard. Therefore, we are not different from abroad after all. I have been to many different countries. I have attended trainings in various countries and I have been in these countries as a trainer myself. And I saw this; We are also doing good work. In some countries in Europe, health care is very expensive. There are health groups that do not or cannot benefit, or some insurance companies say, "This operation is very expensive here, if you go to Turkey, I will pay." There are also such practices. When we look at it in terms of health tourism, we, as Turkey, have advantages. Because we can provide health care at a cheaper price. Therefore, we can be an attractive center in this sense. Of course, I don't know how to direct this. It probably requires collaboration with the Ministry of Health.
How many patients are planned to benefit from Robotic Surgery annually?
If we consider at least 15 cases in a month in gynecology, we have a gynecology target of at least 180200 cases in a year. Of course, the numbers may be different in general surgery and urology. We will see this in the coming days. How much patient load will there be, how intensely it will work, but our prediction is that 1 robot will not be enough in the end. Because in the future, cardiovascular surgery, thoracic surgery or pediatric surgery may also want to use it. Therefore, when you look at it from this point of view, then this will not be very possible with a single robot. 2. The robot should be bought according to these demands. I believe that it will definitely be Ege2, but it is not known when. Depending on the intensity of the patient, it may be in the very early period or it may be in the mid-term period.
Did a robot come between the patient and the doctor? The doctor will examine the patient and decide to have an operation. This does not change, the robot cannot do this. The surgeon will talk to the patient and explain the risks and advantages. The surgeon will also perform the surgery, the robot does nothing on its own, it needs to be managed by a surgeon who does his job well.
Therefore, experienced surgeons can perform good robotic surgery, inexperienced surgeons cannot perform good robotic surgery. This message has to be given. An inexperienced surgeon can never come and do a good robotic surgery. Because in order to control the robot, it is necessary to know it well. If you don't have laparoscopy experience, you don't have a feeling with the robot, all that remains is to see and feel with a three-dimensional image. You must have a good experience in it. As a result, there is no such thing as a robot doing it, it's just a surgeon doing the surgery. The robot is just a tool, the surgeon does everything. Doctors and surgeons have disappeared and it is very difficult for only robots to do the job, it is utopian for now.
Can robotic surgery be applied to all types of patients? For example, will obese patients also benefit?
Yes, especially obese patients are very important. Because when you do open surgery on them, you cut 1Ocm20 cm sometimes 30 cm of adipose tissue. It takes a long time to heal. Infection occurs, the wound does not close. As such, the patient may have to stay in the hospital for days. But we can also perform all kinds of surgeries on obese patients with robots and send them home the next day. The robot will make this possible.
"We are at the top in Turkey in Endoscopic Surgery"
Ege University Faculty of Medicine has made many investments in the last period and developed the latest technological device park. How do you evaluate these developments in the field of medicine?

Endoscopy Surgery at Ege University is at the highest point in Turkey. First of all, the public should know this. Ege University performs endoscopy surgery at the highest point. We are extremely assertive in this regard and we are the university that provides the most education. We are definitely number one in the field of gynecological endoscopy. Because we have only one training program and the number of operations we perform is certain, their quality is certain, their level is certain, our obstetricians and assistants from all over Turkey that we have trained so far are certain. I am currently the scientific secretary of the Middle East Gynecological Endoscopy Association (MESGE). Our gynecological endoscopy training program is a center accepted by the Middle East Endoscopy Association and this is stated on the website.
As EgeTip, we are breaking new ground in many ways. For example, in 2008, I performed the surgery to remove the uterus through a single hole for the first time in Turkey. Normally, the navel is entered through the navel and 23 holes are drilled on the sides. We performed this surgery with a system where both the camera and all other instruments are inserted only through the navel. In this context, we want to be the first institution in Turkey to initiate robotic surgery training. Our goal is to start robotic surgery training at the end of May. We have incorporated the robotic surgery simulator. Maybe later, the 2nd console will be bought, we will make a new first in Turkey, we will be an institution that provides robotic surgery training.


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