In January, it has been one year since robotic surgery was introduced at the Karazanashvili Robotic Center (KRC). This technology is one of the most significant and innovative achievements of modern medicine, allowing for highly precise surgeries. This method ensures better outcomes for patients, faster recovery, and maximum safety guarantees.
The robotic surgery service is the only one in the South Caucasus and offers many advantages compared to open surgery or laparoscopy. The first robotic surgery at Karazanashvili Clinic was performed on February 27, 2024, and within one year, the number of these surgeries exceeded 150. Robotic surgeries are performed in the fields of urology, gynecology, and abdominal surgery.
“Robotic surgery is one of the most significant breakthroughs in medicine; it is the latest step in the development of modern surgery, and it represents the present. If we want to be competitive, this is essential – surgery without robotic techniques will not suffice. I believe that with this, our surgery has reached the level of developed countries. This method allows us to perform procedures that were previously impossible with laparoscopy or open surgery. Robotic surgery is an enhanced version, offering more comfort, where the surgeon can see the finest details in 3D. It is minimally invasive and allows for very delicate movements, which, naturally, positively affects the patient,” says Professor Guram Karazanashvili, Doctor of Medical Sciences, robotic surgeon, and oncologist-urologist, who first introduced robot-assisted surgery in Georgia at his clinic, making cutting-edge Western standards in medicine accessible to people.
_Mr. Guram, could you explain the essence of robotic surgery and what advantages this technology offers compared to traditional surgical methods?
_Robotic surgery is the latest step in the development of modern surgery. Previously, we had open surgery, then laparoscopy came along, and now robotic laparoscopy. More precisely, this is called robot-assisted laparoscopy. It is the next stage in the development of laparoscopy, where the surgeon does not directly manipulate the instruments with their hands but rather through the hands of a robotic system.
The problem with regular laparoscopy is the lack of flexibility in the instruments, which cannot be maneuvered inside the body. Just as we, surgeons, can move our wrists and hands in various directions, the robotic instrument moves similarly. It has joints like a human hand, and inside the patient’s body, it becomes an extension of our microscopic hands. These joints allow the movements to be as refined as a human hand’s. The robotic instruments and the robot’s “eye” (essentially, our microscopic eye) are inserted into the abdominal cavity through laparoscopic incisions, controlled by the surgeon. The advantage of this method is that the surgeon sees the operating field in 3D, with minute details, and the robot operates like an artificial hand, ensuring ideal results.
Additionally, there is another big advantage – the surgeon has two hands, while the robot has four. So, besides their own two hands, the surgeon controls four hands inside the abdominal cavity simultaneously. In this case, the robot is a tool for the surgeon, controlled by a console. It is, so to speak, the surgeon’s servant – what is called a “master-slave” system in English.
_Could you speak about the system’s safety mechanisms? How safe is the process, and is there a chance the robot could malfunction?
_Robotic surgery was initially developed for space technology and remote operations. In this case, the robot is controlled from a console, which can be far away. This is advanced technology; the robot does not pose any threat to the doctor or the patient. In the event of any issue, it immediately blocks itself. There is no chance of the robot malfunctioning, as it has multiple safety mechanisms in place to assist the surgeon in performing the operation successfully and to eliminate even the slightest risk to the patient. For instance, if the surgeon were to become unwell during the operation or drop the instrument, as soon as they move away from the console or if anything unusual happens, the robot locks itself completely. This high-level technology not only avoids danger but also protects the surgeon from accidental movements and errors.
Moreover, the type of robot we have (“TOUMAI”) is a global leader in telemedicine. Tele-surgery is no longer the future – it is the present. The robot is so stable and reliable that it enables remote surgeries to be performed routinely over distances of 5,000 to 13,000 km.
_ What was your goal when you introduced robotic surgery in Georgia, and what challenges did you face? Was it difficult to master the nuances that come with this technology?
_ The goal of introducing the technology was for us to be at the level of modern medicine and surgery. Today, robotic surgery is the surgery of developed countries—whether in Europe, America, or Turkey, it is a standard procedure. In Georgia, we were practically lagging behind in this regard, as we did not have modern surgery. So far, I have performed thousands of surgeries using open and laparoscopic methods, and that is my biggest surgical experience. With the robot, I’m not doing anything new; I’m performing surgeries, but with a new tool.
Laparoscopy is no longer modern surgery; it belongs to the past, while robotic surgery is the present. If we want to be competitive, it cannot happen without this type of normal surgery. I believe our surgery has now reached the level of developed countries. By the way, robotic surgery is not just a matter for one clinic; it’s a strategic and significant issue for the country. It’s important so that our patients no longer have to travel to Turkey, Israel, or Germany to receive modern surgical assistance. Our prices are 3-4 times lower than those in Turkey. I’m sure that other clinics will soon acquire robots because this is a major leap forward for all clinics.
_ How many and what types of surgeries have been performed at the clinic using the surgical robot over the past year?
_ In one year, we have performed over 150 surgeries. Our clinic performs all types of surgeries: urological, gynecological, abdominal surgery, all kinds of urology prostate, bladder, kidney, oncological surgeries, reconstruction of urinary fistulas in women, treatment of urinary incontinence caused by bladder prolapse, ureteral reimplantation, plastic surgeries, kidney tumors, partial kidney removal (which means removing the tumor while preserving the kidney, a very complex procedure), prostate cancer surgeries with preservation of male potency and urinary continence, bladder cancer, and more. We started with urology because, worldwide, robotic surgery was initially adopted by urologists since urology involves complex surgeries where robots are irreplaceable. Our entire urology team has transitioned to robotic surgery. We have also trained an abdominal surgeon and a gynecologist who have begun performing surgeries. We’ve performed operations for stomach cancer, colon cancer, ovarian and uterine cancers. So, we are transitioning the entire abdominal surgery field to robotic surgery.
_ What has been the most challenging robotic surgery in your practice?
_ We have performed very complex surgeries in urology, such as bladder cancer surgeries where the bladder and prostate need to be removed, and then a new bladder is constructed from the intestine. Prostate removal surgery is very complex because the prostate is located deep in the body, surrounded by blood vessels, nerves, bone structures, and intestines. It’s a very delicate operation. Prostate cancer is a common disease, affecting one in seven men, but the good news is that if caught early, it can be cured after the tumor is removed. This cure should happen without compromising the patient’s quality of life, and the robot allows us to perform this extremely delicate surgery in a way that avoids issues like urinary incontinence or loss of potency, and the patient can go home within three days. Recently, we performed a kidney tumor surgery on a young man who had a large tumor, 7 cm in size. He was told everywhere that the kidney had to be removed, but we were able to remove the tumor and preserve the kidney. I must say, this is an amazing technology with zero blood loss, and in all 150 cases, we never needed a blood transfusion, and recovery was very fast.
_ It’s clear that the “TOUMAI” surgical robot provides comfort for the surgeon, but what are the benefits for the patients?
_ The operation involves minimal risk, with zero blood loss. 2. It preserves all vital structures (blood vessels, nerves…) in a way that doesn’t worsen the patient’s quality of life. It’s not just about removing everything; we want the patient to maintain their quality of life, which the robot allows. 3. Less pain, even compared to laparoscopy. Since laparoscopic instruments are less flexible, the robotic instruments are articulated, resulting in much less trauma and minimal, or even no, postoperative pain. 4. Rapid recovery—this period is twice as short compared to laparoscopy. So, this method has huge advantages.
_ Has this innovation become popular and in demand? How is the patient inflow? I understand you have had patients from abroad as well…
_ The fact that we performed over 150 surgeries in one year, which is a large number even for Europe, probably indicates that robotic surgery is already popular in Georgia. I think people were already aware of it, which is why they were traveling abroad for robotic surgery. Now that the robot is in Georgia, they come to us. There is serious interest and demand from our neighboring countries. We have had patients from Armenia, Azerbaijan, Kazakhstan, Uzbekistan, Turkmenistan, and the southern part of Russia. We’ve also had patients come from the U.S. and Europe.
_ Looking ahead, what new developments can we expect in this field? Are there other exclusive technologies at the clinic?
_ Our clinic is one of the most technologically advanced in the Black Sea region, especially in urology. We have other robotic technologies as well, such as robotic focal therapy, which allows us to destroy prostate cancer while preserving the prostate without surgery. We have diagnostic tools for early prostate cancer detection that are more effective and cheaper than MRI, and they can detect tumors more intensively at multiple points. We also have a Swiss device for breaking stones, which can break any type of stone. When someone has to visit five times to break a stone, but still can’t due to its location or hardness, this is not an issue for us. We can break any stone without surgery using this device. Robotic technology is constantly evolving, and we plan to keep up with it, using it in even more areas in the future. Robotic surgery is already spreading to neurosurgery and even cardiac surgery, with new types of robots being developed all the time. This is an inexhaustible field, and as a robotic center, we plan to follow this technological development in modern medicine.
