EndoGastric Solutions Europe

Dr Adrian LOBONTIU is Director of the European Physician Education at EndoGastric Solutions, Inc. a privately held corporation, located in Redmond, Washington, USA, pioneer in endoluminal, incision-less surgery for the treatment of upper gastrointestinal diseases, including gastroesophageal reflux disease (GERD) and obesity, where he trains and demonstrates surgery techniques in Europe.

Institution web pages:
http://www.endogastricsolutions.com/
http://intuitivesurgical.com

Interests: General Surgery, Endoluminal Surgery, Robotic Surgery, Tele-Surgery, Minimally Invasive Procedures. Launching new and innovative surgical technique in Europe and USA. Implement US Medical Device Companies and young Start-ups in Europe.

Details:

"Dr Adrian Lobontiu is surgeon at Henri Mondor Hospital http://chu-mondor.aphp.fr/ – Paris 12 University, France in the Cardio-Thoracic and Vascular Surgery Department, in charge for Robotic Tele-Surgery and Minimally–Invasive procedures.

He is Director of the European Physician Education at EndoGastric Solutions, Inc. a privately held corporation, located in Redmond, Washington, USA, pioneer in endoluminal, incision-less surgery for the treatment of upper gastrointestinal diseases, including gastroesophageal reflux disease (GERD) and obesity, where he trains and demonstrates surgery techniques in Europe.

Prior to joining EndoGastric Solutions, Inc., Dr Lobontiu was Clinical Manager, Europe for the California, USA - based Intuitive Surgical Inc., today’s world leader in surgical robots (NASDAQ - ISRG) where he introduced a revolutionary technology in Europe, obtained CE mark before FDA approval and initiated the world’s first robotic surgical procedures (European results leveraged to raise 80 MUS$ in company’s IPO). He established key direct contacts by training top surgeons in following specialties: cardiac, urology, general surgery and vascular surgery and demonstrated robotic surgery techniques in Europe and USA.

Dr Lobontiu held the Director position for the Robotic Surgery Module at the European School of Surgery in Paris.

He teaches the Master of Biomedical Engineering of Health at the University of Medicine René Descartes, Paris – France and the DIU (Diplôme Inter Universitaire) of Robotic Surgery at Jussieu University in Paris.

Dr Lobontiu is member of the SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), CATEL (Club des Acteurs de la Télémédicine – France) and of the “l’Amicale” of Surgeons of the European Hospital Georges Pompidou in Paris.

Dr Adrian Lobontiu is medical journalist - permanent correspondent in Paris of the Medical Romanian Journal: "Viata Medicala".

Dr Lobontiu holds a Medical Degree and General Surgery Degree from the University of Medicine Targu Mures and a General Surgery Diploma Degree with Specialization in Laparoscopic Surgery from Pierre et Marie Curie University of Medicine - Faculté de Médecine Saint-Antoine, Paris.

He is internationally published and invited speaker at International Conferences and Congresses for innovative surgical techniques.

As author, together with different teams across Europe and USA of numerous world’s first surgical techniques, he helps implement US Medical Device Companies and young Start-ups in Europe and has proved successful medical business in launching new innovative surgical procedures, techniques and products."

Selected publications:
• Doctor Adrian LOBONTIU, Doctor Daniel RABREAU, Professor Daniel LOISANCE. Endoluminal Robotic Surgery: Zenker Diverticula Approach. In Dallas April 26-29, 2006 (SAGES: Society of American Gastrointestinal and Endoscopic Surgeons). 2006.
• Adrian Lobontiu. "Chirurgia Robotica: Bypass coronarian pe cord in activitate." Viata Medicala, 824, p. 7, 2005.
• Adrian Lobontiu. "Robotically Assisted Closed Chest Coronary Artery Bypass Grafting Surgery on Beating Heart: Technique Description." Romanian Journal of Cardiovascular Surgery, 4, pp. 68-72, 2005.
• Adrian Lobontiu. "Robotically Assisted Closed Chest Coronary Artery Bypass Grafting Surgery on Beating Heart: Technique Description." Romanian Journal of Cardiovascular Surgery, 4, pp. 68-72, 2005.
• Adrian Lobontiu. "La téléchirurgie : une nouvelle manière d’opérer". In "Le Parisien", Nr. 18883, p. 4. 2005.
• Adrian Lobontiu, Pascal Desgranges. "Robotically Assisted Aorto-Femoral Bypass Grafting Technique." Romanian Journal of Cardiovascular Surgery, vol.4, no.1, pp. 34-38, 2005.
• Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, Verhaeghe JL, Meistelman C, Degueldre M, Villemot JP, Guillemin F.: "Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients." Surg Endosc, 2005 May 3.
• Adrian Lobontiu. "Robotic Surgery: new indications. In Invited speaker at the 2nd National Romanian Congress of cardiovascular Surgery." 2004.
• Adrian Lobontiu, Andras Hoznek. "Robotic Kidney Transplantation Video technique." Mondor Hospital, Paris web site, 2004.
• Adrian Lobontiu and Andras Hoznek. "Chirurgie assistée par ordinateur". In Electronic Publication on the urology website, Henri Mondor Hospital, Créteil, France. 2004.
• Desgranges P, Bourriez A, Javerliat I, Van Laere O, Losy F, Lobontiu Adrian, Melliere D, Becquemin JP. . "Robotically assisted aorto-femoral bypass grafting: lessons learned from our initial experience." European Journal of Vascular and Endovasc Surgery. 2004 May; 27(5):507-11. , 2004 May;27(5):507-11., pp. 507-11., 2004.
• Adrian Lobontiu. "Télé chirurgie, un nouvel abord chirurgical". In Conference at the European Hospital Georges Pompidou, Paris, France. 2003.
• Le Matin Suisse. "Ce Robot c'est la Playstation 3". Le matin Suisse, Jan 11, p. 8, 2003.
• Adrian Lobontiu. "Robotic Surgery in Turkey." In CNN Interview on Robotic Surgery at Memorial Hospital, Istanbul, Turkey. 2003.
• Gettman MT, Hoznek A, Salomon L, Katz R, Borkowski T, Antiphon P, Lobontiu Adrian, Abbou CC. . "Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system." Journal of Urology, 170(2 Pt 1):, pp. 416-9., 2003.
• Hubert J, Feuillu B, Mangin P, Lobontiu Adrian, Artis M, Villemot JP. "Laparoscopic computer-assisted pyeloplasty: the results of experimental surgery in pigs." British Journal of Urology International, 2003 Sep;92(4):, pp. 437-40., 2003.
• Adrian Lobontiu. "Des chirurgiens robots dans les salles d'opérations". In Reader's DigestSelection, 12, p. 70. 2002.
• Adrian Lobontiu. "Il Sistema Chirurgico 'da Vinci' per la chirurgia computer-assistita" (Italian). In Conference on Robotic Surgery at the Italian Congress of 'Innovazione Technologica e Servizi per la Salute'. Modena, ITALY, April 3-5, 2002.
• Adrian Lobontiu. "The da Vinci surgical Robot performing telesurgery." Archives of the Balkan Medical Union. New series, Vol.37 Nr 1, pp. 49-53, 2002.
• Hoznek A, Zaki SK, Samadi DB, Salomon L, Lobontiu Adrian, Lang P, Abbou CC. "Robotic assisted kidney transplantation: an initial experience." Journal of Urology, 167(4):, pp. 1604-6., 2002.
• Adrian Lobontiu. "Is there a Robot in the Operating Room?". In "Conference at the 5th International ARGOS Symposium (Association of European Research Groups for Spinal Osteosynthesis)", January 26, 2001; Paris, France. 2001.
• Adrian Lobontiu. "The da Vinci Surgical System performing computer-enhanced surgery". Ospedali d’Italia Chirurgia, July-August; 7, pp. 367-721., 2001.
• Abbou CC, Hoznek A, Salomon L, Olsson LE, Lobontiu Adrian, Saint F, Cicco A, Antiphon P, Chopin D. "Laparoscopic radical prostatectomy with a remote controlled robot." Journal of Urology, 165(6 Pt 1, pp. 1964-6., 2001.
• Ève Coste-Manière, Louaï Adhami, Renaud Severac-Bastide, Adrian Lobontiu, John Kenneth Salisbury Jr., Jean-Daniel Boissonnat, Nick Swarup, Gary Guthart, Élie Mousseaux, Alain Carpentier: "Optimized Port Placement for the Totally Endoscopic Coronary Artery Bypass Grafting using the da Vinci Robotic System." In "International Symposium on Experimental Robotics", Waikiki, Hawaii, USA, pp. 199-208. 2000.
• Abbou CC, Hoznek A, Salomon L, Lobontiu Adrian, Saint F, Cicco A, Antiphon P, Chopin D.: "Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case." In: Progress Urologie, 10(4):, pp. 520-3, 2000.
• Gautreau C, Grosse H, Fabre M, Soubrane O, Woimant G, Lobontiu Adrian, Kojima T, Cherruau B, Devillier P, Houssin D, Cardoso J. "Intravenous immunoglobulin delays xenogeneic hyperacute rejection in a model of pig liver perfused with human blood." In: "Transplantation Proceedings", Apr;28(2, p. 764., 1996).

Source:
http://www.ad-astra.ro

Endoluminal Fundoplication in Europe (reflux)

EndoGastric Solutions(TM) Announces 80% Success Rate Of Their Endoluminal Fundoplication (ELF) Procedure Using The EsophyX(TM) Device

"EndoGastric Solutions(TM) announces successful completion of their Phase 1 study of EsophyX(TM) for the treatment of gastroesophageal reflux disease (GERD). The ELF procedure was offered as a new incisionless surgical treatment for GERD for the first time in 2005 in Brussels, Belgium to 18 patients who were dissatisfied with GERD medications and awaiting laparoscopic Nissen fundoplication surgery. All patients treated with EsophyX(TM) were able to discontinue their GERD medications after the procedure and over 80% of patients remained completely off medication at one year post-ELF procedure. In addition, over 80% of patients were very satisfied with the procedure and would recommend it to their family and friends. Such a high patient satisfaction with ELF was primarily related to being free from reflux and burning pain as well as being able to eat and drink what they wanted as a result of restoring a robust valve at the gastroesophageal junction.

The most objective measurement of acid reflux is the pH in the esophagus. Acidic pH in the esophagus indicates that acid is being refluxed or regurgitated from the stomach into the esophagus. This reflux is the typical GERD symptom experienced by millions of people world-wide as heartburn, regurgitation or pain, which has a severe impact on the patient's quality of life. At one year after the ELF procedure, 63% of patients had normal esophageal pH indicating that the patients were not experiencing reflux.

Another benefit of the EsophyX(TM) device is that it can also reduce hiatal hernias, which occur when the stomach rises above the diaphragm and into the chest. These hiatal hernias often cause severe GERD. In the Phase 1 study of EsophyX(TM), 76% of the patients had hiatal hernias prior to the ELF procedure. All hiatal hernias were successfully reduced by the EsophyX(TM) device and remained reduced at one year post-procedure.

The primary investigator for the Phase 1 study was Professor Guy-Bernard Cadiere of the St. Pierre University Hospital in Brussels. 'This is the first endoluminal product that mimics surgery and has shown results that approximate surgical efficacy' stated Professor Cadiere. 'The ELF procedure can also be revised or redone to tighten the newly created gastroesophageal valve if the valve should loosen over the course of many years. This is a big advantage over the Nissen procedure, which is complicated and difficult to revise.' Professor Cadiere has currently performed over 65 ELF procedures using the EsophyX(TM) device. 'In my experience using EsophyX(TM),' explains Cadiere, 'I have never seen the adverse effects, like gas bloat syndrome or dysphasia that are typical of surgical treatments.'

Dr. Amin Rajan from CHIREC Hospital is the gastroenterologist partner of Professor Cadiere who assisted in performing the ELF procedures. 'I am very impressed with the EsophyX(TM) device. We are very satisfied with the results and patients report a dramatic quality of life improvement compared to their life before the procedure. Patients love it and most have already recommended it to their families and friends suffering from GERD. As a physician representing the gastroenterology community taking care of thousands of patients suffering from this disease, we are thrilled. We have been waiting for an endoluminal solution for years and finally, we have one that we can recommend to our patients.'

The EsophyX(TM) device and ELF procedure have been available in Europe since mid 2006. EsophyX(TM) is not available for sale in the U.S. at this time.

'Surgeons have been waiting for a less invasive procedure that yields similar results to the time tested Nissen Fundoplication,' states Dr. Scott Melvin of Ohio State University, who is on the Advisory Board for EndoGastric Solutions(TM). 'EsophyX(TM) has the potential to change how we treat GERD.'

Thierry Thaure, Chief Executive Officer of EndoGastric Solutions(TM), states that 'We are excited about this new platform technology and anticipate that results will only improve over time as we iterate the product and refine the procedure. This is just the beginning.' Thaure further elaborates, 'We are pleased that patients can finally experience the efficacy of surgery without skin incisions or internal incisions. We hope this less invasive approach will allow physicians to reduce pain, recovery time and cost of obtaining a significant anatomical 'fix' and treat the root cause of GERD.'

About GERD

GERD is acid reflux with heartburn that is frequent and severe enough to impact daily life and damage the esophagus. Normally after swallowing, a valve between the esophagus and stomach opens to allow food to pass into the stomach and then closes to prevent reflux of the food back into the esophagus. In GERD, this valve is weakened or absent, causing the acidic digestive juices from the stomach to flow back (or reflux) into the esophagus. This reflux is not only dangerous, because the esophagus is made of delicate tissue that cannot withstand the caustic, acidic contents of the stomach, but it is also painful, and 'burns' the throat (and is, therefore, called 'heartburn'). Reflux of these stomach contents can also lead to a precancerous condition called Barrett's esophagus and/or adenocarcinoma, a full blown cancer that is very aggressive and deadly.

Drug Treatment of GERD

Current medical treatment of GERD includes drugs, such as H2 blockers and proton pump inhibitors, which neutralize or suppress the stomach acid and help relieve symptoms. However, these drugs are expensive, they don't work for everyone, and many people who do respond quit responding over time. Although over $13 billion is spent annually on proton pump inhibitors alone, these drugs do not correct the root cause of GERD (anatomic disintegration of the antireflux barrier) so symptoms return when the medication is stopped. More effective and permanent solutions are needed.

About Surgical treatment of GERD

Surgical treatment of GERD by long, open incisions on the abdomen or by laparoscopy (usually 5 ports or small holes in the abdomen) has long been known to effectively treat GERD. However, this surgery is invasive, with considerable cutting both inside the patient around the stomach area, and on the abdominal skin. This surgery, generally called Nissen or laparoscopic fundoplication, also causes concerns. The effectiveness of the Nissen procedure is highly dependent on surgeon skill, as the procedure is complicated, and effectiveness is reduced with inexperienced surgeons. The Nissen can also cause problems if it is done too tight, and patients can experience 'gas bloat syndrome' where they experience cramps, pain and trapped gas. Other undesirable effects can include difficulty swallowing, painful swallowing and/or inability to burp or vomit. Despite these problems with the previous surgical approach (Nissen), the surgery is generally effective at reducing reflux by creating a valve at the base of the esophagus where it joins the stomach.

About Endoluminal Fundoplication (ELF) procedures

Until recently, the primary commercially available treatments for GERD were medications or surgery. With the ELF procedure, an additional option that mimics surgery but involves no abdominal or internal incisions, has become available. The EsophyX(TM) device by EndoGastric Solutions(TM) (EGS), is used to perform an endoluminal fundoplication (ELF). The ELF procedure involves entering through the mouth to deliver fasteners in the stomach with the goal of creating a 3 to 5 cm thick flap of tissue in 270 circumference at the base of the esophagus. This flap valve rests closed against the other side of the stomach at the junction of the stomach to the esophagus, to prevent stomach contents from refluxing back into the esophagus. Patients who have reflux disease generally have lost this flap valve and/or the junction of their esophagus to their stomach has stretched out allowing food to reflux or regurgitate back into the esophagus. These patients generally need an anatomical reconstruction to relieve their GERD symptoms. The ELF procedure, performed using the EsophyX(TM) device, mimics many of the principles of the laparoscopic fundoplication, including that EsophyX(TM) reduces hiatal hernia, restores the angle of His and creates a gastroesophageal valve. However, EsophyX(TM) does not have the same issues with adverse effects that are seen with Nissen.

About EndoGastric Solutions

EndoGastric Solutions(TM) is a pioneer in endoluminal procedures for the treatment of upper gastrointestinal diseases, including GERD and obesity. EGS's mission is to utilize the most current wisdom in gastroenterology and surgery to develop new trans-oral procedures and products to address the largest unmet needs in gastrointestinal diseases. EGS's initial solutions involve modifying current open surgical and/or laparoscopic approaches using trans-oral access. The company designs and manufactures single use instruments that will enable these incision-less solutions, and focuses on clinically based products for use by gastroenterologists and surgeons. EGS is a privately held corporation, located in Redmond, Washington with a European office and distribution center in Milan, Italy and training offices in Brussels, Belgium and Strasbourg, France. Investors include MPM Capital, Advanced Technology Ventures, Foundation Medical Partners, Chicago Growth Partners and Oakwood Medical Investors."

For more information:
http://www.egseurope.com/
http://www.egsglobal.net
http://www.endogastricsolutions.com

Source:
http://www.medicalnewstoday.com

Another source of information is available at Wikipedia.org :

Endoluminal Fundoplication
"In June 2006 EndoGastric Solutions introduced EsophyX ELF in the Europe Union as an alternative to surgical and pharmaceutical approaches for the treatment of GERD. EsophyX ELF is intended to deliver similar benefits as the time-proven laparoscopic fundoplication procedures, by reducing hiatal hernia, recreating the Angle of His, and creating a GastroEsophageal Valve (GEV). The key differences are that EsophyX ELF is an endoscopic non-invasive procedure that is performed transorally (through the mouth), does not require incisions, and does not dissect any part of the natural anatomy.

Previous endoluminal treatments focused predominantly on the LES. However, failure to effectively treat reflux long-term with endoluminal therapies which focused only on the Lower Esophageal Sphincter (LES) combined with the fact that surgical approaches like Nissen fundoplication recreate the GEV and have excellent long-term efficacy, has led to an awareness that the GEV is probably the most powerful component of the Anti-Reflux Barrier. The device has been designed to deploy multiple tissue fasteners to create a robust and durable valve and is intended to restore the geometry of the GastroEsophageal Junction and recreate the natural, unidirectional valve mechanism necessary to prevent GERD. EsophyX ELF has not been cleared by the US FDA and is not yet available in the US."

Schweiz: Die «Insel» operiert neu vierarmig (Inselspital Bern)

Am Wochenende hat das Berner Inselspital seinen ersten Operationsroboter in Betrieb genommen. Das Inselspital hat ein neues Hightech-Gerät – einen vierarmigen Operationsroboter für schlüssellochchirurgische Eingriffe. Für einmal sei es im Kanton Bern mit einer Spitalinvestition schnell gegangen, sagen Ärzte.

"Wie zwei Händchen greifen die kleinen Zangen nach Nadel und Faden und treiben sie in die rosa Haut des toten Schweins auf dem Operationstisch. Bedächtig führen sie einige Stiche aus und schliessen die Naht in eleganten Bewegungen mit einem Knoten ab. Die Zangen sind die äussersten Enden von grossen Armen einer Maschine, die wie eine Spinne über dem Tisch schwebt. Zwei Meter weiter sitzt konzentriert der Chirurg Arvind Kumar vom All India Institute of Medical Science New Delhi vor einer Steuerkonsole. Kumar ist der stille Meister über das Geschehen auf der Schweinshaut. Über Hebelchen und Pedale führt er die Arme und Zangen. Er selber beobachtet die Miniszenerie durch zwei Gucklöcher, die in der Konsole dreidimensional den Eindruck vermitteln, er sei direkt am Ort der Operation. Der Zuschauer kann sie auf einem Flachbildschirm an der Hightech-Spinne verfolgen."

Ferngesteuerte Bewegungen

"Chirurg Kumar kam ans Berner Inselspital, um sich mit 20 Berufskollegen aus aller Welt in Trockenübungen mit dem Operationsroboter Da Vinci vertraut zu machen, den die Insel neu angeschafft und am Wochenende für eine Tagung zur Verfügung gestellt hat. Alle haben Erfahrungen mit der minimalinvasiven Chirurgie – der so genannten Schlüssellochchirurgie –, bei der ohne Aufschneiden über kleine Öffnungen im Innern des Körpers operiert und das Geschehen auf einem Bildschirm verfolgt wird. 'Der Roboter bietet auf diesem Gebiet völlig neue Möglichkeiten', sagt Ralph Schmid, Chefarzt Thoraxchirurgie an der Insel. Er mache damit seiner Benennung nach dem italienischen Renaissancekünstler Leonardo da Vinci alle Ehre. In der herkömmlichen Schlüssellochchirurgie führe der Chirurg die Instrumente von Hand. Der Stab mit den Kameraaugen und dem Lämpchen, der neu an einem Roboterarm befestigt ist, müsse umständlich von einer zweiten Person gehalten werden. Das Bild sei nur zweidimensional. Der Begriff 'Roboter' sei indes irreführend. 'Die Maschine macht nur das, was man ihr vorgibt.'

Nebst dem leichten Söiliduft liegt am Institut für experimentelle Chirurgie der Insel denn auch Aufbruchstimmung in der Luft. Die Chirurgen beugen sich über das Angebot an 5 bis 8 Millimeter grossen Scheren, Klemmen und Skalpellen, die an die Roboterarme montiert werden können. 'Mit Da Vinci kann ich die Instrumente nahezu so führen wie bei einer offenen Operation', sagt Schmid. Dank ausgeklügelter Technik haben die Roboterarme genau die gleiche Bewegungsfreiheit wie die Finger und Handgelenke des Chirurgen an der Konsole und vollziehen jede Bewegung etwa fünfmal verkleinert nach. Der Roboter bringt auch Vorteile gegenüber der offenen Operation. So kann der Chirurg während des Eingriffs sitzen. Wenn er die Instrumente loslässt, behalten sie ihre Position. Die Elektronik filtert das Zittern aus den Bewegungen. Das System habe jedoch keine 'taktile Rückmeldung', bedauern die Chirurgen. 'Wir denken oft mit den Händen', sagt Tom Treasure vom Guy’s Hospital London. Daran werde gearbeitet, sagt Kevin Horton von der kalifornischen Herstellerfirma."

Aufschneiden, wenn es blutet

"Weltweit sind 500 Da-Vinci-Systeme im Einsatz, 350 davon in den USA. In der Schweiz ist das Berner Inselspital das sechste, das den Roboter angeschafft hat, und das erste, das mit der neuen vierarmigen Generation arbeitet. Vor fünf Jahren kaufte sich das Universitätsspital Zürich Da Vinci. Es folgten die Genfer Privatklinik Beaulieu, die Zürcher Privatklinik Hirslanden, das Kantonsspital Aarau und das Unispital Genf. Am meisten durchgesetzt hat sich das Gerät im Fachbereich der Urologie. Wie Chirurg Jens Rückert vom Unispital Charité Berlin erklärt, werden in den USA bald 50 Prozent der Prostataentfernungen bei Männern mit Da Vinci ausgeführt. Mit dem Roboter könne schonender operiert werden als bisher, was oft die Erektionsfähigkeit erhalte und Inkontinenz vermeide. Ein vielversprechendes Anwendungsfeld sei auch die Gynäkologie. Der Roboter sei am besten für kleinräumige Eingriffe geeignet. Daher sei er in der Thoraxchirurgie – bei Operationen am Brustkorb – erst im Kommen. In seiner Klinik würden bereits alle Thymusdrüsenentfernungen mit Da Vinci ausgeführt, bei Lungenoperationen bestehe Zurückhaltung. Wie Insel-Chefarzt Schmid sagt, sind Eingriffe im Thorax gefährlich. 'Wenn es richtig blutet, müssen wir auf konventionelle Methoden umstellen'."

Schneller, mit weniger Fehlern

"Hubert John, Chefarzt Urologie der Hirslanden-Klinik in Zürich, konnte mit Da Vinci die Operationszeit für eine Prostataentfernung von viereinhalb auf drei Stunden senken, wie er im August gegenüber 'Gesundheit-Sprechstunde' sagte. Die Patienten verliessen das Spital bereits drei Tage nach der Operation und gingen drei Wochen später wieder zur Arbeit. Jens Rückert betont in erster Linie die neue Qualität der Operation. Studien belegten, dass mit Da Vinci weniger Fehler wegen mangelnder Ausbildung gemacht würden als mit bisheriger Schlüssellochchirurgie, auch legten Chirurgen eine grössere Geschicklichkeit an den Tag."

Neue Freiheit am Inselspital

"Da Vinci wird in Bern als Erstes in der Urologie zur Anwendung kommen. Schon vor gut drei Jahren sei das Gerät bei der Insel-Leitung ein Thema gewesen, sagt der Chefarzt Urologie, Urs Studer. Diese habe das Geschäft dann wieder aktiviert, als der renommierte Urologe George Thalmann vom Zürcher Unispital abgeworben zu werden drohte. Thalmann blieb in Bern, nachdem ihm die Leitung der Urologie nach Studers Pensionierung 2010 zugesichert wurde.
'Da Vinci ist das erste Beispiel der neuen Freiheit am Inselspital', sagt Studer. Endlich sei es mit einer Spitalinvestition in Bern mal rasch gegangen. Seit Anfang des Jahres kann das grösstenteils kantonal finanzierte Unispital Investitionen von zwei Millionen Franken selber beschliessen. Vor dem neuen Spitalversorgungsgesetz betrug der Rahmen eine Million. Die genauen Kosten will Studer nicht nennen. Der Preis sei Teil eines 'Deals' mit der Herstellerfirma. So führe die Insel als Teil der Abgeltung Kurse durch, was angesichts des internationalen Echos aber positiv sei."

Druck von der Strasse

"Der Druck für die Schlüssellochchirurgie komme von der Strasse, nicht von den Herstellerfirmen, sagt Thoraxchirurg Ralph Schmid. Wenn Roboter Eingriffe schonender machen könnten, 'gehen die Leute dahin, wo die Maschinen sind.' Die Hirslanden-Klinik Zürich hat für Prostatabehandlungen einen Vertrag mit der Krankenkasse Helsana abgeschlossen. Dies zeige, dass Roboterchirurgie wegen der raschen Genesung auch für die Krankenkassen und letztlich die Gesundheitspolitik interessant sei, sagt Chef-Urologe Studer.
'Ein Meilenstein' sei die Erfindung der Schlüssellochchirurgie Anfang der Neunzigerjahre gewesen. Der Roboter sei nun die zweite Phase der Entwicklung. Studer betont aber: 'Ist der Chirurg hinter der Konsole nicht gut ausgebildet, nützt alle Technik nichts'."

Mehr zum Thema:
Originalseite als PDF

Quelle:
http://www.espace.ch

Hôpital : 'Y a-t-il une crise du bloc ?'

"C’est ce que se demande la nouvelle revue Hôpitaux Magazine.
Le trimestriel consacre un dossier au sujet, et publie notamment un entretien avec le Pr Guy Vallancien, chef du service d’urologie à l’Institut mutualiste Montsouris, à Paris. Le praticien revient sur son rapport sur l’état de la chirurgie en France, et déclare : 'Je voudrais dire que contrairement à ce qui a été dit dans la presse, le rapport ne dit pas qu’il faut fermer les structures [qui réalisent moins de 2 000 actes par an]'.
'On a simplement indiqué qu’il y avait des blocs opératoires en sous-activité chronique et avec un nombre insuffisant de chirurgiens. On sait dans le métier que ceux qui travaillent bien sont ceux qui répètent régulièrement leurs gestes', poursuit Guy Vallancien.
Le spécialiste note que 'ce rapport a fait beaucoup parler. [...] Il a fait râler ceux qui s’étaient engagés sans trop savoir pourquoi dans la voie du maintien forcené de leur bloc opératoire et de leur maternité. Le tout bien souvent sous la pression des médecins mêmes de l’hôpital qui s’appuient sur les associations de défense des usagers qui elles, ne savent pas forcément quels sont les risques encourus par la population lorsqu’on maintient un petit service de chirurgie'.
Guy Vallancien ajoute que 'maintenir un petit service de chirurgie, c’est risqué ! [...] Il faut reconnaître que le chirurgien qui sait tout faire, c’est fini ! La spécialisation est passée par là et aucun Français ne souhaite vraiment être opéré aujourd’hui par quelqu’un qui fait à la fois les yeux, la tête, le thorax et l’abdomen ! Or, si l’on veut exercer dans une spécialité, il faut aussi être en nombre suffisant pour assurer la continuité des soins.'
Le praticien estime enfin qu’'il y a de la résistance parce que les Français sont traditionalistes. Très inventifs isolément, totalement figés collectivement ! Il y a de ce point de vue là une responsabilité évidente des médecins et des élus. Les premiers responsables de cette inertie sont en effet les médecins, notamment les chirurgiens qui ont été parfois en première ligne dans ces combats pour garder leur emploi'.
Hôpitaux Magazine publie en outre un texte du Pr Marc Zerbib, chirurgien urologue à l’hôpital Cochin, sur 'le métier de chirurgien'.
Le praticien écrit notamment que 'le chirurgien était il y a une trentaine d’années le roi de l’hôpital, il en est aujourd’hui le pigeon : celui qui a eu tort de s’engager dans une profession qui a si peu d’avantages pour tant d’inconvénients'.
'Mais je crois que ces difficultés relèvent d’une phase transitoire. Le métier de chirurgien est en mouvement rapide, il se transforme et va nécessairement progresser par le renouvellement des techniques dans les années à venir. La vocation va réapparaître, du moins on peut l’espérer', poursuit Marc Zerbib."

Source :
Hôpitaux Magazine numéro 1
Revue de presse rédigée par Laurent Frichet (Médiscoop)