The Da Vinci robotic system has brought a revolution in the treatment of prostate cancer, and the first Da Vinci surgeries in Croatia were successfully performed at the International Medical Center Priora in Čepin, near Osijek, in June 2024.
November is the month when awareness is raised worldwide about the importance of men’s health. Through the global Movember movement, men are encouraged to undergo regular preventive checkups, detect prostate and testicular cancer early, and support each other in maintaining physical and mental well-being.
According to data from the Croatian Institute of Public Health, 862 men in Croatia died of prostate cancer in 2024, making it the third leading cause of cancer death among men. About 2,600 men are diagnosed with this malignancy every year, which makes it the most commonly diagnosed cancer in men in Croatia.
The Da Vinci robotic system has brought a revolution in prostate cancer treatment, and the first Da Vinci surgeries in Croatia were successfully performed at the International Medical Center Priora in Čepin, near Osijek, in June 2024. What the team has learned from this remarkable robot over the past year and a half is shared by Tomislav Kalem, M.D., head of the urology department at Priora.
Looking back 18 months, what has your experience with the Da Vinci been like? How satisfied are you?
“I’m delighted that during this period we performed nearly one hundred procedures using the Da Vinci system. Most were radical prostatectomies, and the rest included kidney tumor resections and pyeloplasty procedures. All surgeries went smoothly without complications, and we prepared carefully and thoroughly for each case. In this demanding process of mastering the robot, we were guided and supported by our mentor Dr. Georg Schön, who has performed more than 6,000 Da Vinci operations, making him one of the most experienced surgeons in the world on this system.”
How did the patients recover?
“Patients were discharged between the second and fourth day after surgery and recovered according to all European and global standards of care. We are proud that our results — outcomes, hospital stays, and complication rates — match those of German and other European clinics whose work we monitor and compare ourselves with.”
What were the biggest challenges in implementing the Da Vinci system?
“The biggest challenge was introducing the method into a facility that had been built and opened only six months before the first robotic surgery — we were literally starting from scratch. Learning to operate with Da Vinci wasn’t simple either, but my colleagues and I already had extensive experience in open and laparoscopic surgery, which greatly aided us. Most importantly, we had an outstanding mentor. Without Dr. Schön and his 6,000 procedures under his belt, we wouldn’t have mastered the technique so quickly. Thanks to his support, we immediately advanced to the fourth level of training, the so-called retroperitoneal surgery, meaning we operate on the peritoneum, directly targeting organs such as the kidney and prostate.”
What are the main benefits of Da Vinci for the patient?
“The greatest advantages are the small incision and speedy recovery. Patients stay in the hospital for a maximum of four days — a duration not possible with traditional methods, where recovery often requires eight to fourteen days. All the technical advantages of Da Vinci translate directly into patient benefits, including faster mobility, a quicker return to daily activities, and significantly less pain. Patients can take a shower the next day and even walk around; some received visitors in the hospital courtyard just a day after surgery. Rehabilitation is rapid, and both continence and potency are preserved thanks to the system’s precision.”
And what are the advantages for the surgeon?
“With Da Vinci, the surgeon practically has four hands operating simultaneously. The robot’s arms have extraordinary mobility, with a range of motion up to 540 degrees and millimeter precision, surpassing the limits of the human hand. The entire operation is viewed in 3D on the monitor, and Da Vinci’s optics provide tenfold magnification, allowing us to see and preserve even the finest nerves.
There is also the ability to control abdominal pressure and minimize bleeding — the technical capabilities of this robot are truly extraordinary. Moreover, the surgeon operates while seated in an ergonomic position, extending career longevity and preserving valuable surgical expertise.”
You often emphasize that it’s the surgeon who operates, not the robot. Why is that important to point out?
“It’s important to clarify because people sometimes think the robotic system works like an industrial CNC machine — you upload a program, and the robot performs the work on its own. In reality, every movement of the Da Vinci robot is fully controlled by the surgeon. None of its actions is autonomous.
In the United States, robots that autonomously perform gallbladder surgeries using artificial intelligence already exist — the surgeon only supervises. That robot operates faster than humans and achieves excellent results. I hope such technology will one day become available for prostate surgery as well. There have even been remote surgeries, where, for example, a surgeon in Paris operates on a patient in Shanghai.”
How do patients react when you explain the Da Vinci’s capabilities? Are they skeptical at first?
“Patients today are extremely well-informed and have access to a wealth of information. Our role as doctors is to clarify what they might not fully understand. The patient–doctor relationship has evolved; with more available knowledge, it’s easier to explain what a particular procedure involves and what to expect.”
You treat patients not only from Croatia but also from other countries.
“Most of our patients come from Croatia, followed by neighboring countries such as Bosnia and Herzegovina and Serbia. We also receive patients from Germany and Austria.”
Da Vinci has undoubtedly pushed the boundaries in prostate cancer treatment. Is it the future of medicine — will it soon become the standard?
“It already is the standard in Europe. In Germany, most surgeries are performed using the Da Vinci system — not only in urology but also in gynecology, thoracic surgery, and abdominal surgery. Given the benefits it brings to patients, I believe it will soon become the standard in Croatia as well.”
What advice would you give to colleagues just beginning to work with Da Vinci?
“I’d advise them to find a certified training center as soon as possible and practice regularly. The Da Vinci system includes simulation-based training programs where surgeons can rehearse every procedure using highly realistic virtual avatars.”
