Robotic surgery has been around for many years. In fact, the first major milestone in the field of this kind of surgery was when the robot PUMA 200 was used for needle placement in a CT-guided brain biopsy more than 25 years ago. Since then, scientists have developed and introduced progressively more cutting edge technology, changing the face of medicine forever.
According to South African urologist, Dr Kabo Ijane, who practices at the Urology Hospital in Pretoria and qualified as a robotic surgeon, after training both locally and in Europe, it’s imperative that more surgeons embrace robotic surgery so that it can become a mainstream practice in hospitals around the world. Ijane is also Africa’s first black robotic surgeon.
Robotic surgery has successfully been used in almost 2 000 major urological procedures at the Pretoria Urology Hospital. It became the first South African institution to acquire a robot six years ago, and was the first hospital in South Africa to perform robotic surgery, implement a robotic pharmacy picking system and now has one of only a handful of 3D laparoscopic surgical units in South Africa.
This form of surgery is experiencing dramatic global growth due to multiple benefits and is expected to hit $24 Billion by 2025. But what is it and how does it work?
When you think of robotic surgery, the first thought that comes to mind is probably that it's only you and a robot in the operating theatre – without any surgeon involved. But robotic surgery just refers to a scenario where human surgeons use robotic tools to operate on you.
The robotic surgical system enters the patient through a tiny keyhole incision. The surgeon controls the arms while seated at a computer console near the operating table, which gives a high-definition, 3D view of the surgical site.
The robotic instruments are powerful and useful, but the surgeon is always in control. For this reason, it’s best to think of it as "robot-assisted" surgery.
The top advantage of robotic surgery is that it allows surgeons to perform complex surgical procedures using a minimally invasive approach. The robotic instruments also give surgeons a 3D view of the inside of a human body, which is a tremendous advantage over standard laparoscopic surgery where everything viewed is two-dimensional (2D).
“Robotic surgery affords us more precision, allows us to access difficult places, and there’s the advantage of magnification and three-dimensional viewing,” said Ijane, who is one of 17 qualified robotic surgeons at the Urology Hospital.
The 3D view introduces "depth" for the surgeon, and this better visualisation extends their ability to perform a surgery more precisely and allows them to perform very technical and delicate actions.
“From a patient’s perspective, recovery is much quicker, they spend much less time in hospital (about two days compared to up to 10 days for open surgery), they're back at work much sooner – sometimes within two weeks – and generally don’t require blood transfusions,” he added.
Without the robotic equipment, surgeons often have to make large incisions in order to reach the organs they need to operate on. This leaves the patient with big, ugly scars and long recovery times. However, with robotic surgery, because the incision is a lot smaller than with traditional surgery, it looks more cosmetically pleasing.
The instruments can also access very tight spaces that surgeons can’t reach with conventional instrumentation during open or laparoscopic surgery.
Less blood loss
Perhaps one of the greatest advantages is that there’s less blood loss. The Swedish Medical Centre states that about 30% of patients will get a blood transfusion after open surgery, but the transfusion rate is less than 1% when robotic surgery is used. If patients don’t require a blood transfusion, this means they won’t feel anaemic and will have more energy than after open surgery.
Since qualifying, Ijane has conducted 11 prostatectomies (removal of cancerous prostate) and plans to expand to other procedures. Ijane adds that the Urology Hospital also conducts regular robotic procedures for bladder and kidney conditions and says the future of robotics may include reconstructive urinary work, pelvic floor procedures, ventral hernias and gynaecological operations such as hysterectomies and myomectomies.
“With robotic surgery the sky’s the limit. The potential to do multiple procedures is endless and is limited only by what patients and medical aids can afford,” he said.
Should all surgeries involve robots?
Because robotic surgery allows for more precise vision, instrument control and dexterity, it is ideal for many surgeries. It’s gradually replacing traditional open surgery in many fields, including prostate, pelvis, urology, cancer of the rectum and various other ailments.
It’s critical that each patient be evaluated on an individual basis, as robotic surgery is not the best option in all cases – which means that there will still be a need for laparoscopic and open surgery in the foreseeable future.