Tygerberg at forefront of surgical training with Da Vinci robot

Sue Segar

Photo | Intuitive

The future of advanced surgery undoubtedly lies in technology and, increasingly, in using robotics for complicated surgical procedures. As such, it was a big moment for Stellenbosch University’s Faculty of Medical and Health Sciences (FMHS) when, in February 2022, the first operation using the newly acquired Da Vinci Xi robot was performed at Tygerberg Hospital in Cape Town.

Since then, dozens more operations have been successfully completed using this highly sophisticated robotic system. It is currently being used across multiple platforms – in general surgery, urology and gynaecology – to perform a wide range of procedures.

The Da Vinci Xi is the most advanced surgical robot in Africa, and one of only two such robots in use on the African continent. (The other one is used at Groote Schuur Hospital, also in Cape Town.) This robot allows surgeons to operate remotely, using four dexterous ‘arms’, and is controlled in real time via an immersive 3D console.

Tygerberg Hospital’s acquisition of the Da Vinci Xi robot means that public-sector patients now have access to the best surgical technology available anywhere in the world.

Dr Tim Forgan, a colorectal surgeon at Tygerberg Hospital and a lecturer in the FMHS, says the availability of this robot offers a valuable opportunity to illustrate the high levels at which state hospitals can function.

Forgan was the leader of the surgical team at Tygerberg Hospital that performed South Africa’s first robotic gastrointestinal surgery procedure at a public hospital when they removed a cancerous rectal tumour from a patient. He says the robotic system means public-sector patients “will now be able to return to their previous lives that much sooner.”

The robotics training programme

In tandem with acquiring the robot, the FMHS also developed a robotics training programme with the aim of upskilling hospital surgeons and senior trainees in the use of modern surgical systems across multiple disciplines.

“Surgery is progressing rapidly on the high-tech front, making it safer and more efficient. Tygerberg already has some of the most advanced, minimally invasive surgical skills in the country at its disposal. So, being able to promptly apply these skills to the robot is very beneficial for patients, and substantiates the reputation of Stellenbosch University for producing excellent surgeons,” says Forgan.

“The robot arrived at the hospital in October 2021. We set up a robotics training programme as there is a steep learning curve for trainees to learn to use these machines,”  he says.

Training in the use of the Da Vinci Xi robot consists of three consecutive phases: the development of basic coordination skills, in-service training on how to use the robot, and hands-on surgical training.

“Once the trainees have been through these phases, they are accredited as robotic surgeons. Each branch of surgery has its own requirements for the number of cases to be done before the surgeons are accredited,” explains Forgan.

According to him, a new case has been performed every week since the first operation with the robot. “For us, it has resulted in the incremental development of our skills. We have been doing laparoscopic surgery in our department for 30 years. The robotic process uses similar techniques, with nicer tools. It is a natural evolution in our skill set.”

Forgan says the integration of robotics into medicine to enable minimally invasive surgery is becoming more and more commonplace. “As it does, the price will come down, so access will be improved. Hopefully, this kind of surgery will become the norm, resulting in better patient outcomes.

“Our goal is to improve the quality of our surgery, with the aim to better results and, in the long term, expand this to more and more patients, and more and more branches of surgery or patient care.”

'Incredible benefits for patients'

Prof Elmin Steyn, head of the FMHS’ Department of Surgical Sciences, says the acquisition of the robot has put Tygerberg Hospital at the forefront of surgical training in South Africa and Africa at large.

She stresses that, by the time the robot arrived, the colorectal team had already been performing advanced surgical techniques and were well prepared for the new challenge. “The robot enables us to showcase the capabilities of a state hospital, and enhances subspecialist training in the FMHS.

“As surgeons, we are so excited when we get new toys – and, of course, they bring incredible benefits for patients too. The fact that patients are discharged earlier is good for the state hospital system and much more cost effective, but the real benefit lies in risk reduction and the potentially improved surgical clearance of cancer tissue,” she emphasises.

“It is a huge privilege to have this equipment. We are highly aware of the responsibility to make the best possible use of it, training as many people and benefitting as many patients as we can.”

Photo | Intuitive

“Robotic surgery, also called robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures.

The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3D view of the surgical site. The surgeon leads other team members who assist during the operation.”

Source: www.mayoclinic.org