Technology that safeguards health: what high-precision equipment is used at Moscow hospitals

High-tech hardware has become a pivotal aid to surgeons in the Russian capital, as in the Moscow healthcare system doctors employ robots, gamma knives and other cutting-edge technologies at different stages of treatment from diagnosis to rehabilitation, while surgical interventions have become less traumatic thanks to minimally invasive procedures. It is quite often that Muscovites have a surgery in the morning to be discharged home the same evening and lead a habitual lifestyle starting from the next day.

On the World Health Day, we will tell you what high-tech equipment is available in the operating rooms in the city, how the latest technologies can shorten the rehabilitation period and whether smart devices can replace doctors.

Thousands of operations using smart technology

High-tech medical care primarily implies the use of new sophisticated or unique technologies. In Moscow, it is provided in 45 hospitals as high-precision devices help doctors restore ruptured aortas, transplant the heart, remove tumors, simultaneously transplant the kidney and pancreas, perform abdominal intraluminal surgery, etc., with equipment being applied at all stages of treatment.

Last year saw a record number of high-tech operations (> 185,000) performed on patients at city hospitals and on Muscovites in federal and private centers under the compulsory health insurance scheme, over 73 per cent of them involving minimally invasive and organ-sparing methods, including laparoscopy, endoscopy, arthroscopy, endovascular and X-ray surgery.

4,500 robotic surgeries performed in Moscow in 4 years

Gamma knife, fluorescence, navigation and other aid for neurosurgeons

Moscow’s top most high-tech hospitals are Botkin City Clinical Hospital, Yudin City Clinical Hospital, L. A. Vorohobov City Clinical Hospital No. 67, and Sklifosovsky Research Institute for Emergency Medicine.  The cutting-edge technologies are used in cardiovascular surgery and neurosurgery, abdominal and thoracic surgery, traumatology and orthopedics, transplantation of human organs and tissues, gynecology, and cardiology. Sklifosovsky Research Institute offers a wide range of neurosurgical care: from open neurosurgical interventions to gamma knife radiation surgery. Natalia Drozdova, Chief Executive of Sklifosovsky Research Institute for Emergency Medicine, gave us more details about the latter.

“This is an expensive procedure, but for Muscovites it is free. The device is designed to treat tumors and vascular malformations in the cranial cavity. Radiation from 192 cobalt-60 radiation sources enters the scull without incisions to stop tumor growth by damaging the DNA of cancer cells, while healthy brain tissues and the patient’s body are not exposed to radiation. In December 2020, the gamma knife device was upgraded up to the latest version, which made it possible to provide help to more patients and expand the list of brain diseases curable with the gamma knife. The department also has a 3 Tesla MRI scanner providing better visualization for doctors to precisely plan treatment and to only target affected brain regions during the operation,” explained Natalia Drozdova.

Neuroendoscopy, local fibrinolysis and neuronavigation are of vital importance for doctors today as endoscopic techniques are needed in aneurysm, hemorrhagic stroke, traumatic intracranial hematoma, spinal and brain tumor surgery. How does innovation help doctors? This question was answered by neurosurgeon Andrey Grin, chief freelance specialist with the Moscow Healthcare Department and Chair of the Scientific Department of Emergency Neurosurgery at Sklifosovsky Research Institute for Emergency Medicine.

“Brain surgery is a fine-tuned work. Imagine that a watermelon with clotted blood or a splinter somewhere inside. You need to calculate the trajectory and get inside this watermelon. If at the beginning of the path you move a couple of millimeters in a wrong way, then you will get a 1-centimeter deviation after 10 centimeters and miss it. Moreover, people are different anatomically, and functional zones can migrate. And the brain is still not a watermelon where you can remove seeds. You must not touch speech, motor or other vital structures. And what if there is a tumor? It displaces everything like an elephant in a china shop. So, without high-tech equipment, the risk of making a mistake or damaging the organ is higher,” says Andrey Grin.

In case of a stroke, neurosurgeons used to act as follows: they searched for a hematoma using a CT scanner, drilled a hole into the skull, diluted the brain and removed the hematoma. Now they employ neurophysiological equipment to examine the brain structure and neuronavigation to calculate the safest route. They then make a hole about one centimeter in size and inject enzymes through a catheter to dissolve the blood.

Neuronavigation is also required to fix the spine with screws. Or they use a robot assistant that helps to introduce electrodes in order to place a stimulator deep into the brain for patients with Parkinson’s disease.

 

At Sklifosovsky Research Institute, we also apply fluorescence to remove brain tumors; doctors inject a contrast agent, and the tumor accumulates it, then they turn on ultraviolet radiation and watch where the glowing neoplasm goes and where its remnants should be removed. Previously we had to remove tumors with our hands, whereas now we use microsurgery, while the tumor is extracted piece by piece, and the brain remains intact.

Moscow doctors perform 225 surgeries using unique spine fixation technique

LVAD and online blood analysis

Sklifosovsky Research Institute for Emergency Medicine is also number one in cardiovascular surgery, which is another area of high-tech medicine. It is the only clinic within the Moscow Healthcare Department that offers all types of surgical treatment for chronic heart failure, such as heart transplantation and implantation of a left ventricular assist device (LVAD), which acts as a left ventricle in patients with the weakened heart muscle. In fact, cardiac surgeons of Sklifosovsky Research Institute were directly involved in the development of the domestic device.

They also save AAS and ACS patients and those who urgently need prosthetic heart valves. Moscow healthcare has achieved a significant reduction in mortality in patients with acute cardiovascular disease, says Marat Sagirov, chief freelance cardiovascular surgeon with the Moscow Healthcare Department and Chair of the Cardiac Surgery Department at Sklifosovsky Research Institute for Emergency Medicine.

“State-of-the-art equipment expands the capabilities of cardiovascular surgery. Latest heart-lung machines can analyze certain blood parameters and display them online, while ultrasonic flow meters measure the blood velocity and determine how well doctors are performing cardiac bypass surgery, intraoperatively. In emergency cases, we do conventional median sternotomy, that is, we dissect the sternum longitudinally. After all, the greater the access, the easier it is for the surgeon, and sometimes every minute counts. Elective patients have minimally invasive operations if the intended intervention allows (for example, in case of ascending aortic or valvular heart diseases), with the access is provided through the intercostal space or ministernotomy,” Marat Sagirov emphasized.

Da Vinci surgical robot and 3D joints

Meanwhile, the Botkin Hospital employs a Da Vinci robot to treat patients with liver, pancreatic, oncological or urological diseases. The robot does not operate on patients by itself as this is done by a surgeon who uses joysticks, whereas Da Vinci acts under the surgeon’s commands. Vladimir Bedin, Deputy Chief Executive for Surgery at the Botkin Hospital, explains why it is not easier for a doctor to go to the operating room instead.

Other minimally invasive techniques are also used in the hospital. For example, surgery for a liver injury used to be life-threatening and was performed only through an incision, while nowadays patients with such a rupture are saved with the help of one puncture in the groin, with a catheter brought to the hepatic blood vessel through the femoral artery under the control of the X-ray device and multiple coils blocking the blood flow to prevent blood from flowing into the abdominal cavity. In addition, the institution models tailor-made 3D joints for particular patients.

Living usual life instead of months in hospital

A crucial achievement of minimally invasive surgery is a shorter rehabilitation period for patients in addition to high accuracy of treatment, explains Andrey Grin.

“People generally used to be afraid of the word ‘surgery’, because it meant a 4-month stay in hospital for something to be knitted together. With minimally invasive methods, patients often go home and return to their usual life almost immediately to meet with their family members and show up for work,” said Andrey Grin.

However, even despite the high development of technology, no machine will ever replace a surgeon, no matter how smart it may be. Although devices can minimize inaccuracies, distinguish some nuances that are not visible to the human eye (e.g., tumor boundaries) and get to where human hands will not reach (for example, inside a blood vessel), it is only a professional doctor who is able to supervise the running of an operation. Work load at hospitals has not become less either as surgeons have to spend a lot of time to prepare for a surgery, though the operations themselves may now last half an hour instead of several hours.

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