The future of advanced surgical operations undoubtedly lies in technology, and increasingly in using robotics for complicated surgical procedures. Therefore, it was a big moment for the 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.
Since then, dozens more operations have been successfully completed using this highly sophisticated system.
The da Vinci Xi is the most advanced surgical robot in Africa and one of only a few such robots in use on the African continent. It allows surgeons to operate remotely, using four dexterous “arms", and is controlled in real time via an immersive 3D console.
Tygerberg's acquisition of the da Vinci Xi robot means that public sector patients have access to the best surgical technology available anywhere in the world.
In tandem with acquiring the robot, the FMHS 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.
Dr Tim Forgan, colorectal surgeon at Tygerberg Hospital and a lecturer at the FMHS, said the availability of the robot offers a valuable opportunity to show how a state hospital can function at a very high level.
“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," he said.
Forgan led the surgical team at Tygerberg who performed the first robotic gastro-intestinal surgery procedure at a South African public hospital, when they removed a cancerous rectal tumour from a patient. He said the robotic system means public sector patients “will be able to return to their previous lives that much sooner".
The system is being used across multiple platforms – in general surgery, urology, and gynaecology – offering wide-ranging procedures.
“The robot arrived at the hospital in October 2021. We set up a robotic training programme, as there is a steep learning curve for trainees to learn to use these machines," Forgan explained.
Training relating to the robot consists of three phases: firstly, developing basic coordination and skills; then in-service training on how to use the robot; and lastly 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."
According to Forgan a new case has been done every week since the first operation with the robot. “For us, it has been an incremental development in our skills. We have been doing laparoscopic surgery in our department for 30 years and the robotic process uses similar techniques, with nicer tools. It is a natural evolution in our skill set."
Forgan said the integration of robotics 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 of better results and, in the long term, to 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, said the acquisition of the robot has put Tygerberg Hospital at the forefront of surgical training in South Africa and Africa.
She stressed that the colorectal team had already been performing advanced surgical techniques and were well prepared when the robot arrived. “The robot enables us to showcase the capabilities of a state hospital and enhances subspecialist training at 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 potentially improved surgical clearance of cancer tissue," she added.
“It is a huge privilege to have this equipment and 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 caption: Prof Elmin Steyn and Dr Tim Forgan at the Da Vinci theatre at Tygerberg Hospital.
Photo credit: Damien Schumann