A thoracic surgery team from Ruber International Hospital of Madrid He has recently carried out an intervention considered the first of its kind in the world: robotic surgery to remove a very aggressive tumor in the trachea, performed through a single hole in the chest and without intubating the patientThe case has aroused considerable clinical interest due to the complexity of the affected area and the technique used.
The protagonist is a 66-year-old Venezuelan patient, Pavler Carpiowho traveled to Spain after receiving a diagnosis in her country of a tracheal tumor deemed inoperable. Thanks to the mediation of the González Rivas FoundationThe operation was organized in record time and carried out with the da vinci robot, keeping the patient breathing spontaneously throughout the procedure.
A pioneering intervention with a Da Vinci robot and a single incision
According to the thoracic surgeon Diego Gonzalez RivasDr. [Name], who is responsible for the operation and president of the foundation that bears his name, said the tumor was located in what he describes as "the worst possible location": the tracheal carina, the point where the trachea divides into the right and left bronchi. Despite this difficulty, it was decided to approach the case using a minimally invasive robotic technique based on a only inlet port of about 4 centimeters in the hemithorax.
Through that small incision they inserted up to three arms of the Da Vinci robotThis is something the team itself highlights as a leap forward from standard practice. Other similar robotic procedures are usually performed with several incisions, and Ruber Internacional points out that Surgeries with up to five holes were known, but not with just one. in such a delicate area of the central airway.
The intervention lasted for a few five and a half hours in the operating room and culminated in a satisfactory result. The patient remained off-tubation, breathing on his own throughout the operation, which requires particularly precise anesthetic control and very close coordination between surgeons and anesthesiologists.
Without intubation and with spontaneous breathing of the patient
One of the most striking aspects of this surgery is that the patient He was not put on a ventilator using the classic endotracheal intubation tube. Unlike what happens in most interventions in this area, the team opted to maintain the spontaneous ventilationa strategy that has already been explored in other minimally invasive thoracic surgeriesbut here it applies to a context of extremely high anatomical risk.
This decision implies that, during the operation, The trachea and carina were being manipulated while the patient continued breathing. on their own. For specialists, this reduces certain risks associated with prolonged intubation and mechanical ventilation, but at the same time It requires continuous monitoring. of the airway and a virtually zero margin of error.
The team points out that the area operated on is the "tube" that carries air to both lungs and that Any technical problem during surgery can trigger very serious complicationsEven so, after coordination with the anesthesia service, it was considered that this approach was the most appropriate for the specific case and it was carried out with the expected result.
An extremely rare and high-risk tumor
The patient's diagnosis was a highly aggressive squamous cell carcinoma located in the final section of the trachea, extending to right main bronchus and part of the left bronchusThis type of tumor in that location is described by González Rivas as "extremely rare": a thoracic surgeon may only ever see one or two similar cases in his entire career.
According to the specialist, the procedure was performed on the "trunk" that connects to both lungs. The strategy consisted of severing the trachea and reconstruct the entire carina without the need to resect lung tissue. That is, the tumor was removed and reconstructed the junction of the trachea with the bronchipreserving as much respiratory function as possible.
The size of the tumor was around two centimeters in diameterpractically filling the entire interior of the trachea at that point. According to the team, this circumstance made it very likely that, without intervention, the patient would have suffered a sudden airway obstruction in a relatively short period, with a high risk of sudden death.
The role of the González Rivas Foundation and an international team
The patient's arrival in Madrid would not have been possible without the intervention of the González Rivas Foundation, an entity dedicated to disseminating and applying techniques of minimally invasive thoracic surgery in different countries, especially in resource-limited settings. On this occasion, the foundation not only facilitated medical contacts, but also coordinated the transfer and case planning with Ruber Internacional.
They were part of the operation three thoracic surgeons, two anesthesiologists and three nursesIn addition to Diego González Rivas, the Venezuelan surgeon also participated. Regulo Avilawho has collaborated with him for years, and the Romanian surgeon Mugurel BosinceanuThe Madrid hospital covered the medical cost of the procedure, allowing the patient, whose clinical situation was considered hopeless in his country, to access this treatment.
The patient's daughter, the Venezuelan gynecologist Sol CarpioShe played a key role in the beginning of this whole process. It was she who, through social mediaShe contacted González Rivas, explaining her case and requesting help. According to her account, the surgeon responded in less than 24 hours and in just eight daysThe team had organized all the details to be able to carry out the intervention in Madrid.
Express planning for a borderline case
The patient landed in Spain on December 25After a trip via Colombia, prompted by the difficulties of finding direct flights from Venezuela, he arrived with reports from a CT scan performed in his country, in which the tumor had been classified as inoperable, and with the prospect of a very short and unfavorable evolution if an alternative was not found.
Once in Madrid, the team reviewed the case and, within days, the plan was designed. single-hole robotic surgical strategy without intubationThe intervention took place the Monday following their arrival and, according to those in charge, was conceived from the beginning as a potentially curative surgerynot just palliative.
González Rivas emphasizes that this type of rapid planning does not mean improvisation, but take advantage of accumulated experience in thousands of previous minimally invasive thoracic surgeries. The surgeon has already operated on more than 7.000 patients from 129 countriesThis trajectory is also documented in his book "Healing the World," where he describes the single-incision technique for lung surgery that has now been adapted for the central airway.
This time, the novelty lies in combining that philosophy of minimum number of incisions with the use of the Da Vinci robot and with an environment as delicate as the tracheal carina, also keeping the patient breathing autonomously throughout the surgery.
Spain and Europe facing cutting-edge robotic thoracic surgery
Carrying out this intervention in Madrid once again places Spain on the map of advanced thoracic surgery, in a European context in which Surgical robotics is gaining ground But it is still reserved for high-volume centers with specialized resources. The use of the Da Vinci robot has expanded in recent years to multiple procedures, from urology and gynecology up to certain digestive and thoracic surgeries.
However, experts point out that in the field of central airway surgery -like the carina and trachea- this type of procedure remains infrequent and requires a very demanding learning curveThe combination of a single port, absence of intubation, and complex reconstruction in a single surgical procedure places this operation at a level of specialization that is unusual even within large European hospitals.
In recent years, Ruber International Hospital has been consolidating its commitment to minimally invasive surgery in various specialties, and this operation falls within that strategy. For European institutions, cases like this also serve as technical reference for future protocols, both in the use of robotics and in the selection of patients who are candidates for non-intubation techniques.
Looking ahead, the professionals consulted believe that Not all tracheal or bronchial tumors will be treatable. This technique can open a line of work for very specific cases where the aim is to minimize surgical trauma and accelerate recovery, while maintaining oncological safety.
In this case, the robotic surgery through a single incision and without intubation It takes a step forward in Europe by demonstrating that it is possible to address extremely high-risk pathologies in the central airway from a minimally invasive approach, supported by the experience of highly specialized teams, international collaboration and the impetus of foundations that facilitate access to these therapies for patients from other countries.
