Da vinci robot prostate quota operation

Da Vinci prostatectomy treatment for prostate cancer

Removal of prostate cancer (radical prostatectomy) is the most effective method to date to cure a patient of prostate cancer. The advantage of prostatectomy over radiation therapy is that during the operation the doctor has the opportunity to accurately determine the areas affected by cancer of the prostate, and that the operation does not cause damage to healthy cells in the body. The prostate is removed either with conventional surgery or with a da Vinci prostatectomy.

Traditional surgical intervention (cutting the abdominal cavity or perineum and cutting out the prostate with a scalpel) can lead to unpleasant consequences - urinary incontinence and impotence - since when removing the prostate with a scalpel, you can touch and damage the nerve bundles responsible for erection (they are located on the sides prostate) and muscles responsible for continence (urinary retention).

Fortunately, in modern clinics, the prostate is removed using Da Vinci robotic prostatectomy, which allows to reduce blood loss to a minimum and preserve both sexual function and normal bladder function.

Unlike other methods of treating prostate cancer, the peculiarity of Da Vinci prostatectomy is that this laparoscopic operation (operation without an incision in the abdomen or perineum) is performed using a robot controlled by the surgeon. The use of the Da Vinci Robot allows the surgeon to perform the operation with greater accuracy and, as a result, reduces the risk of complications for the patient.

Benefits of Da Vinci Prostatectomy

The main advantages of da Vinci prostatectomy over traditional surgical intervention are: - a greater likelihood of maintaining potency, - a greater likelihood of complete restoration of urinary retention, - minimal pain after surgery and the resumption of normal daily activity during the first day after surgery, - minimal blood loss and reduction in the need for blood transfusion after surgery, - precision operation, small scars after laparoscopic punctures instead of postoperative sutures, - fast rehabilitation, short stay in the clinic (the patient is usually discharged after 5-7 days),

Da Vinci prostatectomy technique

Prostatectomy using the Da Vinci robot is not performed with a scalpel, but with precision instruments, the size of which is several millimeters. To get to the prostate, 5 small punctures less than a centimeter in size are made in the lower abdomen. These cameras create a three-dimensional image with a magnification of 15-20 times, which increases the accuracy of the surgeon's movements and reduces the likelihood of complications after surgery. In addition, operating instruments can rotate in different directions at an angle of 90 degrees, so that they have the same maneuverability as a human hand. The hands of the robot copy the movement of the doctor's hands with absolute precision and meticulousness.

Where is prostate cancer treated using the Da Vinci prostatectomy method?

Successful da Vinci robotic prostate surgery requires vast experience with the da Vinci robot and surgical talent. In addition, the purchase of a Da Vinci robot costs a lot of money, and for each operation a one-time set of tools worth several thousand euros is used. That is why a prostatectomy using a Da Vinci robot is done in a very small number of specialized clinics.

The Da Vinci Robot was invented in the United States for particularly precise cardiology surgeries. For the treatment of prostate cancer, the Da Vinci robot was first used in Germany. In Germany, there is the largest European clinic for the treatment of prostate diseases - the European Prostate Center in the city of Gronau near Düsseldorf.

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How to get a GMP quota?

Discovery of a disease that requires high-tech surgical intervention is a common story. Such an intervention can be performed using the method of minimally invasive surgery using the da Vinci robotic platform. The basis of the method is surgery using point punctures in tissues or through natural physiological openings, which avoids large postoperative traces.

It may seem to you that it is extremely difficult to get funding from the budget for high-tech assistance, nevertheless, there is a chance, and the number of operations performed under the quota is growing every year. According to official data, the cost of VMP is growing annually by 20%, and the number of transactions completed over the past 10 years has increased 15 times.

Speaking at SPIEF-2018, Minister of Health Veronika Skvortsova announced the increase in the availability of high-tech medical care (HTMC): "We have significantly increased the volume of high-tech medical care, starting from 60 patients 10 years ago, and now it is more than 1 million according to the results of the past year", - said the Minister

Surgery using the da Vinci robotic platform is expensive, but any patient in need is eligible to receive a state quota for such an operation.

We bring to your attention answers to questions that arise from applicants.

Who is eligible for a free high-tech surgery?

This document is accepted annually.

Which institutions deal with the issue of quotas?

All issues of obtaining financing for High-Technological Medical Assistance (HMP) from the federal budget are regulated by the Ministry of Health.

What diseases fall under the quota program?

View the types of assistance that can be provided with the da Vinci robot here.

Which institutions are eligible to provide High-Tech Medical Care (HICH)?

A medical institution providing high-tech medical care under state quotas must have an appropriate license. All the clinics on our list that have the da Vinci robotic system in their arsenal have such a document.

Is there an age limit for the patient?

There are no age restrictions for minimally invasive surgery using the da Vinci robot.

What steps do I need to take in order to obtain a quota for an operation corresponding to the gold standard of surgery?

Step 1. Contact your doctor.

First of all, the patient should contact the attending physician to obtain a referral for hospitalization, draw up the necessary documents and send them for consideration to the competent organization. The attending physician of the medical organization in which the patient is being diagnosed and treated determines the presence of medical indications for the provision of HTMC and, if there are medical indications, issues a referral for hospitalization. The presence of medical indications is confirmed by the decision of the medical commission of the medical organization, which is drawn up in a protocol and entered into the patient's medical documentation. If there are medical indications, the attending physician issues a referral for hospitalization.

Requirements for issuing a referral for hospitalization:

The referral must be completed on the letterhead of the referring medical organization legibly by hand or in print, certified by the personal signatures of the attending physician and the head of the medical organization, as well as the seals of the attending physician and the medical organization and contain the following information:

• Name patient, date of birth, registration address;
• CMI policy number and the name of the medical insurance organization;
• certificate of obligatory pension insurance;
• code for the diagnosis of the underlying disease in accordance with the international classification of diseases;
• profile and name of the VMP type;
• name of the medical organization to which the patient is referred;
• Name

Attached to the referral:

• an extract from medical records indicating the diagnosis of the disease, the code of the disease according to the international classification of diseases, information about the state of health, the results of special medical studies. The extract must be certified by the personal signatures of the attending physician and the head of the medical organization;
• copy of patient ID or copy of birth certificate (for children under 14);
• copy of compulsory medical insurance policy;
• copy of compulsory pension insurance certificate (if available);
• Consent to the processing of personal data.

The head of the referring medical organization or another employee of the medical organization authorized by the head sends a referral for hospitalization:

To the receiving medical organization, if the VMP is included in the basic CHI program (clause 15.1 of the Procedure);

Important: The patient or his legal representative has the right to submit the completed package of documents on his own. This will speed up the collection and submission of the documentation necessary for obtaining the VMP.

Step 2. It is necessary to wait for the registration of the coupon for the VMP.

There are 2 options for coupon design:

• If the patient is referred for the provision of HTMC included in the basic CHI program, then the receipt of the coupon with the attachment of the set of documents specified in step 1 is provided by the receiving medical organization.

The HMO Commission decides on the presence or absence of indications for referral of the patient to the receiving medical organization within 10 working days from the date of receipt of the full package of documents.The decision of the HMO commission is drawn up in a protocol, which should contain a conclusion on the indications for referral to the VMP or on the need for additional examination.

Note: An extract from the protocol of the decision of the HMO commission is sent to the referring medical organization, and is also handed over to the patient (his legal representative) upon a written application or sent to the patient (his legal representative) via postal and (or) electronic communication.

Step 3. It is necessary to wait for the decision of the commission of the medical organization providing HTMC.

The commission makes a decision on the presence (absence) of medical indications or the presence of medical contraindications for hospitalization of the patient within seven working days from the date of issuance of the coupon for the provision of HTMC.

The decision is drawn up in a protocol containing a conclusion on the presence of medical indications and the planned date of hospitalization of the patient, on the absence of medical indications for hospitalization, on the need for an additional examination, on the presence of medical indications for referring the patient to a medical organization for specialized medical care, on the availability medical contraindications for hospitalization of a patient in a medical organization providing high-tech medical care.

Step 4. After completing the HTMC, receive recommendations.

Based on the results of the provision of HTMC, medical organizations make recommendations for further observation and (or) treatment and medical rehabilitation with the relevant records in the patient's medical records.

What do da Vinci robotic surgery quota applicants need to consider?

The number of quotas is disproportionately less than the number of patients in need of surgery. The classic direct route to getting quotas usually stretches over time.

Where can I find out if there are quotas for High-Tech Medical Care?

The Ministry of Health annually approves the number of quotas for HTMC and other types of treatment. All quotas are distributed among medical institutions licensed to provide such care. Information about how many quotas are left can be obtained from two sources. One of them is the Department of Health, the other one is the clinic where you want to get a VMP.

In any clinic that provides treatment under government quotas, there must be a person responsible for quotas, or there may even be a whole quota department. This is where you need to contact for questions about the availability of quotas.

How many high-tech operations with the help of the da Vinci robot are performed per year, is there any chance of getting help?

In 2017, a total of 2421 operations were performed using a robotic system. Of these, only 5% was paid by private individuals, the rest was financed by quotas.

If a medical center is equipped with the da Vinci system, does this mean that all types of operations can be performed at the medical center?

The use of a robotic system allows for the most complex interventions in urology, general surgery, gynecology, thoracic surgery, colorectal surgery and on the organs of the head and neck. Although the list of operations is quite wide, 70% of all interventions take place in Urology, and robot-assisted prostatectomy is the gold standard in the world in the treatment of prostate cancer. It is important to understand that each clinic develops separate directions. There are multidisciplinary centers where surgical interventions using da Vinci are carried out in different directions, and there are centers specializing in one thing. For example, GBUZ MO "MONIIAG" specializes in gynecology, and all operations are carried out only in this area.

A list of medical institutions that perform surgery using the da Vinci robot is presented on our website, in the "Clinics" section

Urology: Radical prostatectomy, A denomectomy, Kidney resection; autotransplantation; allotransplantation, Nephrectomy, Adrenalectomy, Cystectomy, Bladder resection, LMS plasty, Ureteroanastomosis; Ureterocystoanastomosis, A bdominal testicular resection, Pyelolithotomy, Varicocelectomy.

Abdominal surgery: Hepatectomy, Liver resection, Pancreatectomy, Fundoplication, Cardiomyotomy, Adrenalectomy, PDR (Pancreatoduodenal resection), Cholecystectomy, Selective arterial embolization or partial pancreaticoduodenectomy, Gastrectomy, Nissen fundoplication, Tupe fundoplication, Gastroastrotomy , Abdominal aortic aneurysm replacement.

Colorectal surgery: Rectal resection (anterior and low anterior), BAR (Abdominoanal resection), Hemicolectomy (left, right), Sigmoidectomy, Colectomy.

Thoracic surgery: Segmentectomy, Lobectomy, Bilobectomy, Marginal resection, Mediastinal resection.

Head and neck: Glossectomy, Thymectomy, Theriodectomy, Hemithyroidectomy, Resection of the isthmus of the thyroid gland.

Prostate Removal by Da Vinci

Da Vinci robot for cancer and prostate adenoma

Prostate diseases necessitate the prompt elimination of a focus of benign or malignant tumor processes, which until recently was associated with high risks due to the inaccessibility of the surgical field. The proven effectiveness of robotic surgery is based on the impressive technical features of the unit, which surpasses the capabilities of a single person. Four thin manipulators of the system, controlled by the surgeon-operator, are able to move along a large amplitude and quickly change the instruments used, supplied to the installation by assistants. The surgeon sees a three-dimensional increase in the area of influence, which ensures maximum accuracy of manipulations, as a result - guarantees the preservation of erection and urinary retention function

Indications and contraindications

A radical intervention is recommended in case of diagnosis:

• oncopathologies of various types, encapsulated within the boundaries of the organ;
• acute and chronic prostatitis;
• progressive hyperplasia;
• multiple violations of urination functions (soreness of the process, frequent occurrence of false urges, the appearance of blood in the urine).

Surgery is contraindicated in inflammation of the genitourinary system, hemophilia, lung and heart diseases, severe diabetes mellitus, as well as during the progression of acute respiratory viral infections and other infectious processes.

How does the Da Vinci robot operate?

As part of the preoperative preparation, the patient is fixed in the Trendelenburg position (with the upper body lowered by 10-15), a urinary catheter is inserted. During the provision of general anesthesia, the robot system is fixed within the operating area, after which the surgeon performs the procedure according to the approved protocol:

According to reviews, already on the first day after radical prostatectomy performed on the basis of the Da Vinci robot, patients are allowed to eat light meals and get up, and catheter removal is recommended 6-7 days after prostate removal.

Follow-up treatment and complications

In the case of using the Da Vinci robot, the likelihood of complications associated with the appearance of hematomas and suture failure is minimal (5-8% of cases), urination function is fully restored in 95% of those operated on. The use of robot-assisted surgery methods guarantees minor tissue trauma and low blood loss, which is especially important in the complex treatment of oncopathologies. Due to the short rehabilitation period, a patient who has recently undergone an intervention can undergo the recommended sessions of chemotherapy or radiation therapy in a short time, which has a positive effect on the overall dynamics of recovery.

You can find out how much the removal of the prostate by the Da Vinci robot costs on request by providing the results of a comprehensive diagnosis.