REVO

Feature Article on the presentation session about Revo-i given in the Celebration Symposium of 40,000 Robotic Surgeries at Severance Hospital-Joint Symposium by the Urological Research Society ⓛ

Revo-i Robotic Surgical System in Uzbekistan (Dr. Bakhadirkhanov Mukhamed Zarif, Republican Specialized Scientific-Practical Medical Center of Urology)

In this presentation session, we will mainly talk about how Central Asia's first surgical robot, Revo-i, has been introduced, as well as surgery cases that were performed using this system. First, let's talk about how it was introduced.

Introducing a surgical robot to Uzbekistan was necessary for the advancement of future healthcare in Uzbekistan. During the market research, some brands that are only for sale in selected countries were excluded from consideration, and I happened to learn about Revo-i of meerecompany in South Korea. Prior to making a decision on the introduction, I visited South Korea twice. There, I participated in practical training in a dry lab and observed surgeries in Korea Cancer Center Hospital, which helped me confirm the performance of Revo-i. After the final decision on the introduction of Revo-i, we performed practical training in a wet lab. Thanks to this systematic training, we were able to stably achieve 100 cases of surgery.

In September 2022, there was an event held to celebrate the introduction of Revo-i to Shox International Hospital, the biggest private hospital in Uzbekistan. As Central Asia's first surgical robot, it drew great attention across the Central Asia region. Many stakeholders from adjacent countries, including Kazakhstan, Kyrgyzstan and Tajikistan, attended the event. From Uzbekistan, government officials such as the Minister of Health also attended, which shows the great national level interest in this news.

To meet such interest, we are diligently working in various ways to provide better treatments for the people in our country. In October 2022, Uzbekistan's first symposium on robotic surgery was held to draw attention to robotic surgery among medical professionals. In this symposium, Professor Ali Serdar Gozen, a German urologist and the chair of the EAU Section of Uro-technology (ESUT), demonstrated a live surgery using Revo-i, attracting great interest with more than 300 medical professionals attending the demonstration. In October last year, the second symposium was held at a bigger scale where more than 500 surgeons from adjacent countries attended. These are collectively part of our active efforts to arrange for academic stages to foster surgeons for robotic surgery.

I performed my first laparoscopic 15 years ago when I returned to my hometown, Uzbekistan, after finishing my training in Germany. It was the first laparoscopic simple nephrectomy across the entire Central Asia region. In repeating history, I'm fortunate to be honored to have the opportunity to perform the first robotic surgery in Central Asia.

To date, we've performed 140 cases of surgery using the Revo-i system. Specifically, it includes 32 cases of radical prostatectomy, 28 cases of simple prostatectomy, 20 cases of partial nephrectomy, and 15 cases of radical nephrectomy. When we look at the surgery cases performed over 15 months in 3-month sections, 14 cases were performed in the first 3-month section, but 37 cases were performed in the last 3-month section.

Let me introduce some surgery cases performed with Revo-i. The first case is a pediatric robotic surgery that was performed with a robotic system for the first time ever, using Revo-i, across the globe. The pediatric patient was 10 years old at that time with a big stone of about 8 cm in the kidney. We were able to get rid of it easily with the Revo-i robot system (see Figure 1).

Figure 1. First Pediatric Pyelolithotomy in the world with Revo-i

This is a case of partial nephrectomy in a patient with kidney cancer. The tumor was located in lower part of kidney. The surgery was performed using Revo-i, and the surgical margin was negative.

There was a case of simple prostatectomy performed using the Revo-i robot system as well. The patient was 67 years old with an adenoma weighing 100 g in the prostate, and the patient requested for robotic surgery.

Next, this is a video of the radical prostatectomy case. Suture was performed to avoid bleeding in the dorsal vein complex. Then, the bladder neck was opened. After hemolock clipping of pedicles, remove the prostate. During the surgery, efforts were made to maintain the urethral length that is relevant to continence. We always perform Rocco stitch. So, these were the surgery cases.

Lastly, to finish today's presentation, I'd like to share the news that the second Revo-i is going to be installed in Samarkand of Uzbekistan. Thank you.

Q&As

Q: First, I'd like to say congratulations on your achievements with the Revo-i system. I'm very surprised that you performed more than 20 cases of radical cystectomy using the Revo-i system. My first question is about how you were able to make it happen. As you know, radical cystectomy using a robot system is the most difficult surgery among urological surgeries. Wasn't it very challenging?

A: Right, like you said, radical cystoprostatectomy is the most challenging urological surgery. We are performing all surgeries using the robot without switching over to an open surgery or laparoscopic surgery. The surgery took about 7 hours at first, but now it takes about 5 hours.

Q: I'm from a university in Morocco. We are planning to install the Revo-i robot system in the near future. Could you give me any tips for reducing the learning curve in preparation for starting robotic surgery?

A: If you already have experience in laparoscopic surgery, it won't be very hard to learn robotic surgery. Of course it'll take some time to get used to robotic surgery. Once the robot system is in place, I recommend inviting foreign expert mentors with extensive experience in robotic surgery, rather than trying to overcome difficulties on your own.

Q: Thank you. I'm also curious about whether you had any difficulties in performing prostatectomy using Revo-i. Could you please tell me about it, in comparison with other robot systems if possible?

A: Unfortunately, I have no experience in using other robotic systems. Our hospital only has the Revo-i robot system, and I myself have only ever used Revo-i so far. I think the most important things for the sake of my patients is to always think about their health, so I had no specific difficulties while I have been performing 140 cases of robotic surgery using Revo-i to date. 

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