The precision and safety of robotic surgery

Robotic surgery in knee prosthesis

HPA Magazine 20

Robotic surgery, or more broadly, precision surgery, has arrived, seen, and conquered. The reasons behind its success lie in increased safety and reduced surgical errors and complications, which have exponentially positive effects on the client: less post-operative pain, reduced burden and improved immune system response, faster recovery, lower incidence of infections, and nearly invisible surgical scars.
The HPA Health Group has achieved a significant milestone in this field, deserving our dedicated attention in this edition.

It was in April that we performed the first robotic surgery for knee prosthesis at HPA Gambelas, with the belief that in the near future we will be able to replicate it for hip prosthesis as well.
The robot was conducted by an intelligent milling tool with sub-millimeter precision. Controlled by the surgeon, it reduces the possibility of errors and assists in the placement of the implant, closely reproducing the patient's original knee.
Knee and hip arthroplasties are among the most rewarding procedures for both patients and orthopedic surgeons due to their excellent results. It accounts approximately 10% of the 2,000 annual interventions carried out by the Orthopedics Group (GO) at HPA, and for the past 12 years, it has been one of the areas in which the GO has invested the most in technical and scientific terms.
According to Dr. João Paulo Sousa, coordinator of the GO at HPA, "we believe that with this precise and safe technological option, we will be able to improve our clinical and functional outcomes: reducing the number of dissatisfied patients and possibly shortening hospital stays and recovery time, enabling a safer return to daily activities, as well as increasing the longevity of the prosthesis."
In orthopedics, as in multiple areas of medicine, the contribution of new technologies has been invaluable and growing. An example of this is the Patient-Specific Instrumentation (PSI) system, which involves the execution of specific and personalized cutting blocks for each patient. The GO at HPA has been using this system for over ten years and has become a reference center.
The team's investment in new technologies has generated relevant scientific production, including ten publications in indexed journals, three book chapters, and 60 presentations at conferences. This has contributed to the recognition of the team's training credibility by the Medical Board for orthopedic interns. The introduction of robotics will give a new impetus to this important aspect of medical practice.

The Urology Group at Hospital Particular do Algarve introduced in May, for the first time in Portugal, another minimally invasive surgical technique for the treatment of prostate cancer.
The presentation involved the Focal One® HIFU Robotic System, which utilizes high-intensity focused ultrasound (HIFU) technology. The ultrasound energy transmitted by the Focal One® HIFU system rapidly increases the temperature at the desired focal point, causing coagulative necrosis and precise ablation of the malignant prostate lesion without damaging the surrounding healthy tissues and structures.
This precision is achieved through software that combines 3D images overlaid on magnetic resonance imaging, with all movements being robotically controlled with submillimeter accuracy. Moreover, this technique is also superior in terms of time, as the entire process, including planning, equipment configuration, and the procedure itself, can be completed in 45 minutes, three times faster than most techniques.
The primacy of this robotic system brings four advantages: no incisions, no scars, no blood loss, and no radiation. Additionally, accessibility is a key feature. 
The Focal One® HIFU system offers the possibility, without compromising precision, to access the anterior part of large prostates (up to 40 mm), and it can be customized for multiple lesions, with partial or total excision. Professor Tiago Rodrigues, the driving force behind this new technology at HPA, explains these aspects.
We are very excited about this technological innovation, not only because we are the first to experience it, but also because the Urology Group at HPA Health continues to lead in maintaining the quality of life and well-being of men's health, specifically in prostate carcinoma, the most common male neoplasm in the Western world and the second leading cause of cancer-related death in men.