TEN YEARS OF ROBOTIC PROSTHETIC SURGERY: THE CLINICA SAN FRANCESCO IS THE ONLY ONE IN EUROPE TO CROSS THIS FINISHING LINE

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Ten years of experience with robotic prosthetic surgery. MD Piergiuseppe Perazzini today is the most experienced European surgeon using the robot in operating room.

The Clinica San Francesco celebrates an important goal: ten years of state of the art. It was 2010 when orthopaedic surgeon Dr Piergiuseppe Perazzini, Director of the Orthopaedic and Traumatology Unit, after a journey in Florida (USA) and a training in some American hospitals, decided to import this procedure to Europe.

In January 2011 the Clinica San Francesco performed the first robotic prosthetic operation outside the USA. “I became aware of this new robotic system able to solve some problems that we orthopaedic surgeons encounter during knee and hip replacements – Dr Perazzini explains -. These problems are related to painful prostheses, a not complete functional recovery or patients’ general dissatisfaction”.

The prosthetic surgery allows a greater precision in placement of implant thanks to a system able to repeat perfectly what the surgeon planned based on preoperative CT scan. The simulation on created virtual model allows surgeon to have a picture of anatomy and possible difficulties that could encounter before the patient goes into operating room.

The precision of surgical gesture using the robot ensures a not-invasive surgery. Not invasive means the respect and preservation of tissues, ligaments and bones that allow the patient a quicker recovery, so, to start immediately the rehabilitation. Last aspect, no less important, is the safety of patient. The robotic system works in a defined and controlled field so that it avoids to damage parts not subject to operation and protects the tissues of patient by possible damages.

Today, the Clinica San Francesco is accredited with the Italian National Health Service and holds the highest number of total and partial knee and hip replacements with robot all over the Europe. The performed operations are more then 4.000. The Veneto Regional Government with its deliberation of 14th May 2019 recognized the Clinica San Francesco as “Regional reference centre for the robotic orthopaedic surgery”.

In the past ten years the Clinica San Francesco has become a reference point for surgeons from all over Europe who wish to use the robot in operating room.

Dr Perazzini operates patients from across Italy, trains Italian and European orthopaedic surgeons by courses, skill lab, lectures and training directly in operating room. In these years Dr Perazzini trained over a hundred surgeons on the use of robot.

FIRST OPERATION IN ITALY ON WRIST AND RHIZOARTHROSIS WITH AUGMENTED REALITY

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The Hand Surgery Team has reconstructed the ligament of a wrist and implanted a prosthesis for rhizoartrosis with the help of augmented reality. By 3D viewers, the surgeons could visualize the operating field and useful information on patient, sharing them with colleagues from all over Italy.

First operations of wrist and hand surgery with augmented reality at the Clinica San Francesco to confirm the pioneering spirit of the facility. A new technology – until now used mainly in some sector as air force – that uses a 3D viewer to show, next to real elements, also essential virtual objects to give more information on the patient and lead the surgeon during operation.

The orthopaedic surgeons, specialized in hand surgery, Drs Enrico Carità, Alberto Donadelli and Mara Laterza, on Tuesday 9th March 2021 entered into operating room with gloves, scalpels, masks and 3D viewers. Both operations were performed with the collaboration of Dr Pier Paolo Borelli and remote assistance of 4Solid, the software developer of this technology. During the first operation an important wrist ligament, damaged after a trauma, was reconstructed. During the second one, instead, was treated a rhizoarthrosis implanting a state-of-the-art trapeze-metacarpal prosthesis, that represents a particularly specialized element of the Clinic.

“The use of augmented reality allows to increase the precision of the surgical gesture – Dr Carità explains – visualizing in parallel with the operating field the instrumental tests of patient, technical notes and preoperative planning especially during the replacement. Thanks to the augmented reality it was possible to carry out the operation visualizing in operating field all the instrumental tests and preoperative planning of patients in the form of holograms. All this live: indeed several Italian surgeons were connected and could attend and interact with us”

An innovative system that finds its great utility in sharing the surgical act, in the possibility to show new procedures and help possibly the colleagues during the operation.

“The connected colleagues could comment, ask, express opinions during the most critical steps – Drs Carità and Donadelli conclude -. This new technology will allow to break down the distances, putting national and international specialists in touch and sharing technical, surgical and rehabilitative information. It will be also able to be used for the training helping remotely who wants to carry out operations particularly difficult or needs technical support”.

THE RISK MANAGER IS IMPORTANT FOR PATIENT SAFETY

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The aim of Risk Manager is to make the hospital a place still safer for the patient, that means to reduce as much as possible the probability of error in clinical and care field.

Dr Lorena Zanini is responsible for the risk management.

What are the objectives of the risk management policy?

 ● Enhance the quality of care in order to reduce the risks related to the therapeutic diagnostic process and therefore offer more guarantees of safety to patient.

 ●  Protect the image of facility.

 ●  Protect who carries out his/her own activity within the facility.

When the clinical risk management is optimal?

A management of clinical risk is optimal when ensures:

– An effective communication at different operational levels: is fundamental the communication among workers, especially in the phases of passage and admission of patient between the different care teams.

– The spread of safety culture within the organization and of non-technical knowledges and skills among all workers so that they behave safely.

– The safety of environments and contexts, integrating in the organizational model the different roles that manage the maintenance, the course for the drugs, the devices, biological samples, food, sterilization of materials, wastes, patient transport, and management of internal and external health emergencies.

– The standardization of care processes intended as identification of patient, repeat of important/critical information, prevention of falls and decubitus lesions, hand washing, control of hospital infections, pain management, health emergencies. Integration of clinical-care courses, application of the ministerial recommendations.

– The management of adverse event or avoided event intended as immediate and medium-term aspects, means of communication towards patients and their families, associations for the protection of users and media, support to involved workers and patients and their families.

– Learning by experience (reactive and proactive analysis, survey on safety culture, assessment among peers on safety).