(Adnkronos) – For the first time in Italy and in the world, on 5 November at the San Michele Medical Center in Maddaloni (Caserta), the Symani robot will be used for a head and neck surgery in the oncology field. The event, which is an absolute first in the field of microscopic robotics, will see the participation of experts of international standing, both in person and via video link. The intervention will be aimed at freeing the facial nerve of a patient with a tumor of the parotid gland, a salivary gland that is increasingly affected by neoplasia. Behind this multidisciplinary and cutting-edge event is the vision and intuition of Vito Del Deo, Head of Maxillofacial Surgery at the San Michele Medical Center, Professor of Head and Neck Clinical Anatomy at the English-language Medicine degree course at the Catholic University of Rome and Professor of Clinical Anatomy head and neck at the Faculty of Medicine of the University of Maryland in the USA.
“Leading figures in European specialist surgery will participate – says Del Deo to Adnkronos Salute – such as Professor Henning Wieker of the University of Kiel (Germany), considered one of the leading users in Europe and in the world of Symani, with reconstructive purposes in oncology maxillofacial; Also present will be colleagues from the Schools of Specialization in Maxillofacial Surgery, Professor Gianpaolo Tartaro of the Luigi Vanvitelli University of Campania, Professor Giovanni Dell’Aversana Orabona of the Federico II University of Naples, Professor Pasquale Piombino of the Aco of Caserta, Professor Mattia Todaro for the Catholic University of Rome. Connected ‘live’ Professor Asit Arora, leader of ENT/head-neck robotic surgery in the United Kingdom from Guy’s and St.Thomas University Hospital in London, Professor Alessandro Moro and Giulio Gasparini of the School of Specialization in Maxillofacial Surgery of the Catholic University of Rome, Professor Valentino Valentini of the School of Specialization in Maxillofacial Surgery of the Sapienza University of Rome and Stefano Paulli of the Maxillofacial Surgery of Legnano (Mi)”.
“This event – continues Del Deo – focuses on the potential of robotic surgery with microsurgical applications, not to be confused with the minimally invasive approach. In fact, the term ‘microsurgical’ indicates the execution of a technique in ultra-magnified vision with the aim of reducing the risks of injury, correlated with surgical manipulation, of tissues and anatomical structures, while the term ‘minimally invasive’ indicates the execution of a surgical incision reduced to a minimum”.
The Symani robot, a ‘made in Italy’ robotic system for microsurgery, will be used, given that the Mmi company was founded in Pisa where the headquarters and the research and development laboratory are still present. “To date, Symani is the only robotic system in the microsurgical field capable of optimizing the surgeon’s ability to manipulate very small and delicate anatomical structures for reconstructive and resection purposes – recalls Del Deo – The Symani robot, placed at the operating table, is controlled by the operating surgeon from a console consisting of a pilot’s seat equipped with electromagnetic control and a three-dimensional visual magnification system consisting of a 55-inch screen that receives images from the operating field obtained from an ‘Orbye – Olympus’ exoscope with augmented reality. The surgeon, the assistant and the instrument nurse, equipped with special polarized glasses, can thus view the smallest details magnified 36 times on the screen and use micro-instrumentation and super-micro-instrumentation”.
“Today Symani is used in 15 hospitals in Europe and 4 in Italy, but we will be the first in Italy to use it in head and neck cancer surgery – specifies Del Deo – with the aim of freeing the facial nerve from the tumor of the parotid gland, minimizing surgical insult to the nerve itself, optimizing and speeding up the functional recovery of facial expressions. We will highlight the potential of Symani in the blunt dissection technique, using robotically assisted microscopic instruments instead of the classic instruments in macroscopic maneuver. To date, the ordinary application of Symani is already recognized and established in reconstructive surgery for the execution of microvascular anastomoses (connections between very small arteries and veins) for the transfer of flaps (tissues to be transferred and transplanted to reconstruct removed areas) but we intend to demonstrate that Symani can also be used in dissection techniques”.
How did the intuition of being able to use it in head and neck cancer surgery come about? “I had the intuition during my first simulation experience with Symani at the ABMedica simulation center in Milan – replies Del Deo – On that occasion, observing the range of micromovements that the microscopic instruments could make by varying their direction as if they were the classic instruments ordinarily used for smooth dissection, I developed the vision of the effective and real ability of the system in dissection mode. The thing that most excited me and that pushed me to want to explore the possible evolutions of this robotic system was the immediate agreement with my German colleague Wieker on the vision of the type of intervention in which ideally the real dissective capacity of Symani could be expressed. Even more exciting was learning directly from the Mmi company, and after their feedback on the reasons for my enthusiasm shared with my colleague Wieker, that this ‘vision’ would soon become a reality as the dedicated instrumentation to perform microdissection maneuvers, with tools specifically for cutting, was in the design and development phase; so unknowingly, my colleague Wieker and I were already, with our vision, following what Symani would be able to perform in the near future. The goal – he warns – is to highlight the multivalent functional capabilities of Symani, which will finally be able to express, to the patient’s advantage, 360-degree surgical skills with micro-reconstructive and microdissection applications with optimal respect for the most noble anatomical structures”.
The San Michele Medical Center has been a contracted facility with hospital accreditation for three years in the regional oncology network, also for the surgical treatment of oncological diseases of the facial district, oral cavity and neck. “We are proud to be part of the Oncology network, an important step in guaranteeing increasingly effective and humane care to patients – says the President of the Structure, Doctor Crescenzo Barletta – We can certainly express, with pride, our satisfaction for the contribution we are giving in reducing waiting lists, because every patient, especially if oncological, deserves timely and quality treatment”.
“Every day we work to ensure that patients receive the care they need, when they need it – says the health director, Dr. Luisa Caliendo – the quality of care and the attention dedicated to each individual case has made our Structure a point of reference also for patients from outside the Region. In our medical teams we can count on highly experienced doctors such as Vito Del Deo, who has been working with us for almost 20 years and who has brought with him the competence and human approach in patient care, learned during the years of high-level professional training carried out both in the United Kingdom and in the USA. Today with this innovative intervention Professor Del Deo has made us an active part of a new and extraordinary milestone that opens a new road to the future of robotic surgery”.
“It is my opinion that the young surgeon who intends to undertake the training path in robotic surgery must first acquire sufficient experience in traditional surgery as robotic systems do not allow the operator to directly perceive the deformations of the tissues and structures under the control of the robotic instrument – concludes Del Deo – Thinking then of how it is expected to happen in the near future, the coupling between robotic systems and artificial intelligence, I invite you to reflect that an artificial intelligence is devoid of conscience, a fundamental element that only man is endowed with, and therefore let us remember that we doctors act not only according to science, but also according to conscience”.
