Single-arm surgical robot offers new possibilities for surgery along the mouth

With an investment in 4 new surgical robots, including an innovative one-armed robot, UZ Leuven is fully embracing robotic surgery. As a university hospital and largest training center, UZ Leuven will extend the latest robotic technologies to just about all surgical disciplines.

When robotic surgery started in 2007, UZ Leuven did 200 surgeries a year; by 2023, 1,200 surgeries were taking place in Leuven with a robot. The medical demand for robotic surgery is increasing, so the hospital decided to invest heavily in the latest technology. UZ Leuven recently purchased four additional surgical robots, including one innovative one-armed robot. With a total of six robots, one of which is used in AZ Diest, just about all surgical departments in UZ Leuven will now be able to work with the robot. The new robots will be used in urology, nose, throat, ear, face and neck surgery, gynecology, abdominal surgery, cardiac surgery and thoracic surgery. The robot will also be used more frequently in plastic and reconstructive surgery.

It is our job as a university hospital to scientifically assess robotic technology and investigate for which procedures the new, but also expensive, technology is a real added value
- Prof. Wouter Everaerts

Yet the university hospital also wants to raise a critical voice. The high cost associated with robotic surgery, which can be 1,000 to 3,000 euros higher than for conventional surgery, calls for a careful selection of which procedures can and cannot be done with the robot. Robotic surgery, with the exception of prostate removal, is not currently reimbursed. The hospital bears the costs itself. Comparative studies on recovery time, cure rate and cost-benefit analysis of robotic surgery versus conventional procedures are needed.

Robotic surgery uses the same principles as keyhole surgery: the operation is no longer done with a large incision in the body, but through small cuts of 5 to 12 millimeters. In robotic surgery, the surgeon controls a robot with a console, allowing it to make very precise movements. Moreover, thanks to the specialized camera, the surgeon has a pinpoint 3D view of the surgical field.

For a lot of conditions, robot-assisted surgery can offer benefits to patients. Thanks to the robot, much more complex procedures can be performed via keyhole surgery, which means patients suffer less blood loss, spend less time in the hospital and recover faster. In prostate removals at UZ Leuven, for example, a patient can go home within 24 hours after robotic surgery, whereas previously he remained in the hospital for 5 days. Patients who receive a coronary artery bypass via robotic surgery spend less time in the intensive care unit, have less blood loss and fewer complications than with traditional surgery.

The most frequently performed robot-assisted procedure today is radical prostate removal, which at UZ Leuven is done almost exclusively by robot. Other commonly performed robotic procedures include removal of kidney tumors, bladder removal, uterine surgery, abdominal wall surgery, obesity surgery, removal of lung tumors, throat tumors, tumors in the pancreas, liver, stomach and intestine and cardiac bypasses.

One of the four new robots at UZ Leuven is the so-called single port robot or one-armed robot, which has only been available in Europe since January 2024. The classic robots have four arms to work with and make four holes to perform an operation. The single port has one arm and can perform procedures through one small opening, which is ideal for surgery through natural orifices such as the mouth or anus. UZ Leuven was the first hospital in Belgium to perform transoral surgery (through the mouth) with the single-armed robot for a tumor in the pharynx in early November.

Prof. Wouter Everaerts, urologist and chairman of the robotic surgery working group at UZ Leuven: "We are pleased that we can also work with the one-armed robot. It can offer interesting possibilities for tumors in the pharynx or rectal tumors, where you can operate through natural access. In urology, we now also use this robot for the removal of prostate and kidney tumors, but it is still unclear whether the one-armed robot effectively offers advantages for the patient in this compared to the four-armed robot. We want to try out these technological innovations and compare them in a scientific way. It is our job as a university hospital to scientifically assess robotic technology and investigate for which procedures the new but also expensive technology is a real added value."

As a university teaching hospital, UZ Leuven will also teach all future surgeons, including urologists and gynecologists, to work with the robot during their training. After the first theoretical sessions, surgeons in training will receive practical training. In doing so, they learn how the robot works by practicing on training models and virtual simulators before working with real patients. The four-armed robots at UZ Leuven have a control system for 2 people. This allows the experienced surgeon to remain 100 percent in control of the course of the operation, while a trainee surgeon performs a small portion of the procedure under supervision. Over time, the trainee surgeon learns to perform more complex steps.

Surgeons in training thus get the chance to become acquainted with a wide range of robotic surgery, including more complex conditions and multidisciplinary procedures. Robotic prostate surgery is now the standard procedure in hospitals that have a robot, but in the areas of cardiac surgery, plastic surgery and nose-throat ear surgery, UZ Leuven is a forerunner to perform robotic procedures. The robot center works closely with KU Leuven engineers, who developed robotic applications for, for example, ophthalmology, gynecology and nose-throat-ear diseases. In this way, civil engineering students also regularly come to watch in the operating room.