Team of Prof. Grigor Gorchev, certified to perform operations with da Vinci Robotic System

• Introducing robotic surgery in Bulgaria

The first and unique in Bulgaria to the present moment robot-assisted da Vinci S surgical system has been functioning since January 2008 in the Clinic of Gynecological Oncology, Medical University – Pleven. That became possible after the equipment of a special operating room for minimally invasive surgery and telemedicine. A team of specialists has been trained and certified to work with the robotic system.

• da Vinci S Robotic System

Da Vinci S robotic system consists of three main components:
- Console. That’s the place from which the surgeon performs the real operation. It is provided with safety sensors. The surgeon is sitting on the console in a convenient position, allowing his utmost concentration. He controls the robot working arms, being in constant contact with the operating and anesthesiological team. 
- Patient cart. The four robot arms are located there. One of the arms “holds” the optical camera and the instruments for the operation are attached to the remaining three ones. The arms are covered in sterile “sacks” for single use. Various types of instruments are used depending on the specific intervention. The endo-wrist technology, integrated in the robotic system, allows a great range of freedom and precision of the movements of the instruments as well as the possibility for an intervention in difficult areas for access.
- Vision cart. Here the light sources and the optical camera control systems are located. The console, the monitors in the room and the archive computer system are connected to that part of the robot. The transmission of the three-dimensional image from the operating field to the operating surgeon and his assistants is possible due to that unity of the separate components.

• Robotic Surgery Application

Da Vinci S robotic system at the Clinic of Gynecological Oncology at University General Hospital for Active Treatment Dr. Georgi Stranski – Pleven is mainly used for operative treatment of benign and malignant diseases of the female genital system. Urological operations are also performed since 2010, after the certification of a second team to operate with the robotic system.
- Types of robot-assisted surgical operations
The most frequent operative intervention worldwide is the removal of the uterus – hysterectomy. It could be performed including or not its adnexes (the uterine tubes and the ovaries). In patients with oncological diseases it might be necessary the tissues, surrounding the uterus, to be removed, the so-called radical hysterectomy. The removal of the pelvic lymph nodes is another major stage during the treatment and diagnosis of the oncological diseases of the female genitals.
- Accumulated Clinical Experience
Three hundred and four operative interventions with da Vinci S robotic system were performed from January 2008 to January 2011, including 172 robot-assisted radical hysterectomies with pelvic lymph node dissection, 122 - robot-assisted total hysterectomies, 6 – pelvic lymph dissections and 4 – other operative interventions.