Robotic system introduced to help fight cancer at Cape Town hospital

Called the da Vinci X, the robot is the first of its kind to be introduced not only to the South African operating sphere, but it is also the very first model in Africa.

The da Vinci Surgical Systems are designed to help surgeons perform minimally invasive surgery. Patients benefit too from shorter hospital stays, minimised post-operative pain and reduced recovery time.

Intuitive Surgical, Inc. headquartered in Sunnyvale, California, is the pioneer and a global leader in robotic-assisted, minimally invasive surgery. Intuitive Surgical develops, manufactures and markets the da Vinci surgical system.

About the da Vinci Surgical System
There are several models of the da Vinci surgical system. Da Vinci systems are not programmed to perform surgery on their own. Instead, the procedure is performed entirely by a surgeon who controls the system. Da Vinci systems offer surgeons high-definition 3D vision, a magnified view, and robotic and computer assistance. They use specialised instrumentation, including a miniaturised surgical camera and wristed instruments (i.e. scissors, scalpels and forceps) that are designed to help with precise dissection and reconstruction deep inside the body.

Made by Intuitive in Sunnyvale, California, da Vinci Surgical Systems are advanced robotic-assisted surgical platforms designed to expand a surgeon’s operating capabilities and offer a minimally invasive option for patients. By providing surgeons with superior visualisation, enhanced dexterity, greater precision and ergonomic comfort, da Vinci Systems make it possible for skilled surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. The robot precisely replicates every movement of the surgeon’s hands.

Technology is indeed making life easier as robotics enter the health care system, and Life Kingsbury Hospital is the first Life Healthcare hospital to seek the help of robotics to fight cancer. The hospital has opened its doors to the da Vinci X System to help fight prostate cancer by providing the most advanced surgery available.

Dr Conray Moolman, robotic and laparoscopic surgeon with Cape Urology at Life Kingsbury Hospital says the innovation allows patients another option in the management of their prostate cancer. Patients have been limited by treatment options and the robotic system further expands the treatment options available to patients.

“For me, the important point is that men should just be well informed about these options and make informed decisions regarding their therapy,” explains. Dr Conray Moolman. According to Dr Moolman, one of the benefits of robotic surgery is how small the skin incisions are. In the past, people were left with big scars. Further to this, the robotic surgery has also reduced the recovery time significantly as patients get to go home the next day rather than having to stay for up to a week in hospital.

There is also less bleeding, which translates to fewer transfusions. The patients can return to their normal activities a lot quicker rather than the traditional six weeks. Some patients are back to work in ten days.

“For now, the procedure is available on some of the top medical aids with minimal co-payment,” said Dr Moolman.

According to Gus Castello, senior vice president of manufacturing operations, foreign manufacturers contribute 12% of the value of a da Vinci System. Most of that is from German and Japanese suppliers, which supply some of the complex vision technology. High-definition video display monitors come from Philips’ Femi Division, while the image-acquiring size of the video train comes from Toshiba and Panasonic. From Germany, they get an optical stereoscope, the only one of its kind in the world, according to Intuitive, manufactured to their specifications. Ethicon Endo-Surgery, a division of Johnson & Johnson, supplies the harmonic shears, which use ultrasound to cut tissue. Maxon of Switzerland makes some of the precision motors in the da Vinci.

Intuitive now has a small plant in Mexicali, Mexico, that produces some of the disposable instruments for the da Vinci, but the company insists it will keep the bulk of its assembly in America.

“There is some low-cost leverage to manufacturing the instruments in Mexico, where labour is $6 an hour vs $30 in US,” says Gus Castello. “On the robotic side, it doesn’t make a difference. The learning curve is quite steep. We are the only ones doing this. It costs us millions of dollars to learn how to do systems integration. We have complex algorithms to test for final assembly. There is no leverage in having this thing done in China,” he claims. In its latest fiscal year, Intuitive spent 9.6% of sales on research and development, more in line with a mature software company than a manufacturer.

There are many benefits to having as much in-house control over a robot such as this. “The huge advantage in having manufacturing close to engineering resources is that whenever something happens, we have engineers right here,” says manufacturing director Major. “In a remote situation, it would cost a lot of delay in the process to be away from engineering resources.”

It uses sensors and algorithms that smooth jerks and errant shifts of a surgeon’s hands, and Intuitive called the system the da Vinci in honour of Leonardo da Vinci, who had drawings and plans for the first robot.

Hospitals have been willing to invest in this equipment because minimally invasive surgery avoids large incisions and thus means shorter hospital stays, quicker patient recovery and less blood loss from procedures such as prostate surgery, mitral valve repair, gynaecological procedures and other general surgery.

“Life Healthcare is proud to make this first investment into robotics, which aligns with our strategy to invest in appropriate and proven technologies, remain technologically relevant and drive clinical quality and improved outcomes for our patients,” says Adam Pyle, Life Healthcare South Africa CEO. “Life Healthcare strives to deliver market-leading quality care across our service offerings and one of the ways this can be done is through the use of technology.”

Intuitive pioneered, and continues to be a global leader in the field of robotic-assisted, minimally invasive surgery with the creation of its da Vinci Surgical System more than two decades ago. Now on its fourth-generation system, the Silicon Valley-based company has seen more than five million robotic-assisted surgical procedures performed worldwide, and the da Vinci surgical system benefits explored in more than 15 000 peer-reviewed scientific publications to date.

The Surgical System itself requires only the use of two 8- and one 12-mm wide hole in a patient, for insertion of the two surgical manipulators and a camera. Only the robot and surgical assistants stand over the patient, while the surgeon, the system operator, can be across the room at the surgeon’s console where even the look and feel of the open surgery is duplicated with precision. The whole system consists of three distinct components, which includes the surgeon console, patient-side cart that holds the instruments, and the image processing equipment.

The surgeon console is central to the ability of the da Vinci S HD to perform operations. Other attempts at performing surgery while using video proved difficult. The most prevalent challenge was that of directional reversals the surgeons had to deal with. That’s the counter-intuitive movement that is experienced in traditional laparoscopic surgery. Through the use of the da Vinci S HD Surgical System, the surgeon is able to perform the operation while seated comfortably at a console viewing an unparalleled 3D HD visualisation of the surgical field. As the world’s first robotic surgical system with 3D HD vision, the system provides twice the effective viewing resolution than older models to now offer improved clarity and detail of tissue planes and critical anatomy.

There are several models of the da Vinci Surgical System, and this could be the future of modern medicine as we know it. Judging by the uptake and longevity of the da Vinci thus far – this seems a very plausible reality.