Robotic surgery with a human touch

Learning to wield a robot

Robotic surgery training is very different to regular surgical training because the manufacturers have developed specific training modules for each type of operation.

Proficiency in traditional laparoscopic procedures (which involve inserting a long, thin tube into an incision in the body so as to perform an examination or surgery) is attained in three steps: first observing procedures, then assisting in them and finally performing them. Surgeons using robotic instruments, however, must complete the full certification process associated with each individual procedure.

This process includes training on the specific type of surgery, followed by simulated operations on animal models and cadavers, and then assisting in real procedures. The final step is having a proctor assist with and oversee a certain number of surgeries to evaluate the surgeon’s mastery of the instrument for the final certification.

“Surgery is all about simulation, training and practising. Training to use a robotic instrument is no different. You can compare it to flight simulation because the shared goal between aviation and medicine is to ensure safety,” says Dr Viju Thomas, head of the Faculty of Medicine and Health Sciences’ programme in minimal access gynaecological surgery.

The Da Vinci Xi robotic system was under his control during the first of the three groundbreaking hysterectomy procedures performed at Tygerberg.

“Remember, we’re not learning a new procedure, because we are trained surgeons,” he clarifies. “We’re learning how to use the instrument to do the procedure, and making sure our support staff are also well versed in working alongside the instrument.”

Robotic surgery could potentially be performed remotely, with the surgeon operating the robot from another location. However, Thomas cautions that – while there would probably be no technical limitations such as lost data connection and high input lag – there are concerns around the patient experience.

“SU recently hosted a South African Society of Gynaecological Endoscopy congress where we did the first live surgical broadcast from Tygerberg Hospital. Doing so, we trained about 200 surgeons on laparoscopic surgery and introduced them to the concept of robotic surgery.”

Academic institutions have an important role to play in exposing surgeons to advanced techniques such as these, while demonstrating the correct ethics and principles to follow. While the high acquisition, maintenance and operational costs of the Da Vinci instrument limit its widespread use across a variety of procedures, the University is maximising its use to deliver as much value as possible to the Western Cape Health Department, its project partner.

“While we are not expecting it to dramatically affect public health in the short term, you will be surprised how high-level technology can impact primary healthcare,” says SU Dean of Medicine and Health Sciences Prof Elmi Muller.

“If you leave out advanced medicine from the healthcare ecosystem, you will soon find yourself in a position where you’ve capped what you can do for healthcare in the country. That cap results from losing high-level specialists but can also be from not keeping up with technology. Either way, your healthcare industry stagnates or moves backwards.”