sistema chirurgico, da vicini, chirurgia, robot, operazioni

Tra i settori che beneficiano maggiormente dell’innovazione e del progresso tecnologico un posto di rilievo lo detiene senza dubbio la medicina. Da sempre terreno fertile ma allo stesso tempo impervio, il settore medico-scientifico è un grande banco di prova per le tecnologie all’avanguardia. Tra queste la chirurgia robotica è una delle candidate al ruolo di protagonista assoluto negli anni che verranno. Vediamo meglio di cosa si tratta.

Quando si parla di robot è facile perdersi nella fantascientifica immaginazione di un paesaggio futuristico fatto di grattacieli e macchine che volano. In realtà oggi sappiamo che non è affatto così. I robot sono parte integrante della nostra vita e ci accompagnano da semplici compiti in casa, soprattutto in cucina, a complessi lavori nelle grosse catene di produzione.

La medicina – e in particolare la chirurgia – è da sempre una grande alleata del progresso tecnologico e, a partire dal nuovo millennio, ha accolto con grande interesse una nuova e avveniristica tecnologia: la chirurgia robotica.

Questa “tecnica” è oggi sempre più utilizzata negli interventi in sala operatoria: si serve di robot dotati di quattro braccia, comandate a distanza da un chirurgo specializzato.

Un braccio possiede una videocamera 3D in grado di restituire immagini ad alta definizione al chirurgo che opera dalla console, posta al lato del robot; le altre tre braccia sono in grado di tenere strumenti chirurgici per ottenere tagli, suture e cauterizzazioni; il tutto supervisionato da un equipe formata da medici e infermieri.

Nonostante il nome tutto italiano, il sistema (o robot) “Da Vinci” è prodotto da una azienda d’oltre oceano, la Intuitive Surgical, che ha voluto onorare il più grande inventore di tutti i tempi nato e vissuto a cavallo tra il ‘400 e il ‘500 nel nostro paese.

Schema sintetico del funzionamento di una sala operatoria con robot Da Vinci Fonte: uchospitals.edu
Schema sintetico del funzionamento di una sala operatoria con robot Da Vinci
Fonte: uchospitals.edu

L’azienda americana detiene il monopolio mondiale nella produzione di questi macchinari, grazie ai brevetti su gran parte delle tecnologie utilizzate dai robot.
L’Italia è il terzo paese al mondo per utilizzo di questa tecnologia all’interno delle proprie sale operatorie, con oltre 60 apparecchi su tutto il territorio nazionale e più di 10.000 interventi l’anno. Le regioni con più apparecchi si trovano al nord, in particolare la Toscana, la regione italiana con più apparecchiature ed con i centri più importanti per la formazione in questo campo.

Nonostante il “Da Vinci” sia stato introdotto nei primi anni del 2000 per operazioni di cardiochirurgia, oggi gli ambiti chirurgici che ne fanno uso prevalente sono l’urologia (ndr. le prostatectomie arrivano ad interessare l’80% di tutti gli interventi robotici) e la ginecologia, pur rimanendo largamente usato anche nella chirurgia del tratto addominale e toracico (polmone e cuore).

I principali benefici sono sovrapponibili in gran parte a quelli della chirurgia mini-invasiva: significativa riduzione del dolore e del decorso post operatorio, con conseguente riduzione della degenza ospedaliera e più rapido recupero delle normali attività (con ripercussioni economiche positive a più livelli); maggiore precisione nei movimenti del chirurgo, con riduzione del tremore fisiologico e della stanchezza del medico; incisioni e cicatrici minime, minor rischio di infezione e, soprattutto, minore necessità di trasfusioni grazie alla perdita di sangue particolarmente contenuta.

Ma è chiaro che, se da un lato presenta una innumerevole quantità di benefici, dall’altra, come tutti i tipi di chirurgia, anche questa non è esente da rischi ed errori. La Food and Drug Administration, che all’inizio del secolo ha autorizzato con una certa facilità e rapidità l’utilizzo di queste apparecchiature negli Stati Uniti, dando peraltro il via alla diffusione mondiale, oggi sta indagando sui reali benefici e sulle possibili controindicazioni all’utilizzo di tale tecnologia.

In realtà, ciò che è maggiormente sotto i riflettori è il fatto che il monopolio dei macchinari sia detenuto da una sola azienda (la Intuitive Surgical appunto) che, a quanto pare, non si preoccupa di “addestrare” i medici in maniera adeguata, incoraggiando peraltro le strutture sanitarie di tutto il mondo alla riduzione dei tempi di addestramento stessi. Insomma non è il sistema in sé che viene criticato, quanto piuttosto la politica della azienda che, essendo l’unica produttrice di macchinari simili, comporta ripercussioni in ambito sanitario.

Robot chirurgico Da Vinci Fonte: Wikipedia
Robot chirurgico Da Vinci
Fonte: Wikipedia

Sta di fatto che, critiche a parte, la chirurgia robotica rappresenta il futuro della chirurgia grazie alla quantità di benefici che può dare. Ciò che ostacola attualmente la diffusione massiva di tale tecnologia sono più che altro i costi e la mancanza di competitor della azienda produttrice del “Da Vinci”.

Un robot costa intorno ai 2 milioni di euro e necessità di costi di manutenzione tutt’altro che contenuti. Tuttavia se paragonato ai costi di alcuni interventi in laparoscopia risulta senza dubbio sovrapponibile in termine di spesa sanitaria, ma con un migliore impatto sulla riuscita dell’operazione.

Tuttavia il vero ostacolo è la presenza di una sola azienda produttrice di robot chirurgici. Ciò che ha impedito e continua ad impedire la comparsa di nuove aziende che si interessino a questa tecnologia sono i costi sin troppo eccessivi cui si deve far fronte: i brevetti sono attualmente tutti di proprietà della Intuitive Surgical; inoltre a causa delle continue denunce per errori imputati alla macchina, per una startup sarebbe impossibile far fronte alle spese legali e a quelle di produzione con sottostante pagamento della tecnologia all’azienda madre.

Ciò si ripercuote essenzialmente sul disinteresse, da parte della ditta produttrice, di aggiornare in maniera sostanziale il proprio gioiellino. Secondo la Dottoressa Arianna Menciassi, intervistata da “l’Espresso”, ciò che manca alla macchina sarebbe in realtà di facile implementazione: servirebbe un semplice dispositivo che assicuri il feedback tattile al chirurgo, completamente assente allo stato attuale insieme all’integrazione di dispositivi di sicurezza che impediscano (o riducano quanto meno al minimo) l’errore del medico, come quello che può portare le braccia del robot a scontrarsi tra loro.

Ciò nonostante, il futuro ci riserverà senz’altro qualcosa di positivo in questo campo in cui chirurghi e professionisti del settore credono tanto. Nei prossimi anni, quando questa tecnologia sarà sufficientemente sicura, sarà addirittura possibile operare in remoto da due poli opposti del mondo, semplicemente tramite una connessione ad internet. 

Questo aprirà le porte ad una didattica più facile ed accessibile con costi più contenuti e possibilità di collaborazioni che potrebbero portare ad un progresso scientifico di crescita esponenziale. Ma, almeno per adesso, queste sono tutte speranze riposte fedelmente nelle braccia di un robot.

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