On September 11, Alberto Breda performed a partial nephrectomy (removing part of the kidney). The operation could have gone unnoticed, except for the small detail that the urologist was wearing a suit and tie, and not in operating room pajamas. The reason? It was taking place in one of the rooms of the congress that the European Association of Urology was holding in Bordeaux (France).
The location was no surprise, as it was the world’s first robotic nephrectomy performed on a patient at Beijing Pla General Hospital, China; or what is the same, 8,264 kilometers from the person who was going to carry out the move. Yes, you read that right, between the head of the oncological urology department and the renal transplant surgical team of the Puigvert Foundation and the 37-year-old man with a 3.5-centimeter kidney tumor, there were almost 70 football stadiums.
“I am very aware that we are opening the borders and This is a historic moment in modern medicine.“Breda himself tells EL ESPAÑOL. But he is also “very aware” that “there have been many historical moments like this that have not translated into anything.” In fact, so far only two transcontinental surgical operations have been performed.
Historic moment: Spanish doctor operates on kidney tumor on Chinese patient over 8,000 km away using remote-controlled robot
👉 Alberto Breda, performed the operation from Bordeaux and it is the first transcontinental kidney removal in the world pic.twitter.com/TnN9wsZEoT
– EL ESPAÑOL (@elespanolcom) September 21, 2024
The first took place four days before September 11.. Dr. Jacques Marescaux, located precisely in New York (USA), removed the gallbladder of a patient who was in Strasbourg (France). The second took place in June of the same year, by surgeon Zhang Xu, who successfully performed the first transcontinental robotic prostatectomy (removal of the prostate).
The origin: a pig
Despite the medical stage he experienced, Breda admits that he did not feel any pressure or nervousness. If an experienced surgeon, used to “operating in extreme conditions”, becomes nervous, “bad sign”. There was a risk that it would fail, but everything was very prepared: They had been working on this operation for eight months.. Preparation began in February of this year, when Dr. Breda, from Orlando (USA), performed a nephrectomy on a pig that was in a Chinese hospital; in this case, the distance was greater (about 12,800 km).
For Breda, the patient should not be a few meters away from him “it doesn’t change anything”: “The surgeon sits down, looks through the binoculars and only sees the inside of the patient.” I had the impression that if something was wrong, you couldn’t get up and “open it up.” That’s why he had to trust the surgical team in Beijing, which included his colleague Moisés Rodríguez Socarrás, who came from Madrid to “be by the patient’s side throughout the operation.”
In addition to helping him operate, Rodríguez Socarrás facilitated communication between Breda and the Chinese team, since they did not speak English particularly well. The language barrier was also evident when the doctor met the patient a day before the operation. In addition to the “limited empathy” that characterizes this population, Breda did not know if the patient was nervous about the medical stage in which he was going to play.
What he knew was that the patient He was released the next day of the operation; In a week, he was already at home without any complications. And as the doctor from the Puigvert Foundation points out, there is no difference compared to what he does daily, beyond the latency of 132 milliseconds, a possible problem with the light (“if it goes away, we are in trouble”) or even an attempt to hack the exclusive network that Telecom France and Telecom China had created for this operation.
The problem: bureaucracy
If this had happened, “it would be a disaster“. Even if for the moment there is “little interest” in hacking a network of this type. Now, “if in 10 years 50% of surgical operations in the world are done by telematics, we will have to see how to protect ourselves”, he believes. Bréda.
If it were up to him, to arrive at this “optimistic forecast of the future”, we could start “today”, since the technology and the professionals exist. And distance, as has already been demonstrated, is not the problem. The real problem, Breda points out, is bureaucracy; that is, the agreements reached by the governments of different countries to regulate what is called telesurgery.It’s a political question“, summarizes this urologist dedicated to robotic surgery for 20 years.
During this long career, he has reached several medical milestones. In 2010, he participated in the first kidney harvest from a living donor by robotic surgery. In 2015, performed the first robotic transplant in Spain. “We tried the first time, but we didn’t succeed,” he recalls. He travels to India to be received by Dr. Rajesh Ahlawat, considered one of the fathers of robotic surgery in urology.
She stayed with him for 10 days and, just a week after her return, she performed the country’s first robotic transplant. It was also the first in Europe, although this milestone is shared with Dr. Nicolas Doumerc, who performed the kidney transplant on a patient in Toulouse (France) on the same day as his colleague Breda.Without knowing it, we have carried out the first purely robotic transplant in Europe“.
Almost a decade after this feat, robotic surgery has been implemented in kidney transplantation, with more than 1,000 patients. Breda is convinced that, as this “historic milestone” reality transformed worldwideThe first robotic nephrectomy also becomes the starting point of a new era because of the potential it would have: “We could go to areas with few resources, place a robot and perform the operation from Barcelona,” he illustrates.
This would also serve to train other surgeons remotely; or, as Breda defines it, to spread knowledge without borders.” And if one thing is clear to those who have played in several historical moments of modern medicine, it is that “with personalisms and ego, you fail immediately. When innovative interventions are carried out, you discover that Team is the secret of success“, he concludes.
