Da Vinci Surgical system

Posted on 28 September 2016

Investing in innovation and technology is a major component of the long-term Mediclinic vision. It means patients can expect world-class expertise in its facilities and they can count on the provision of infrastructure that supports the best clinical outcomes.

One example of the value that is derived from the significant investments that have been made in innovation and technology is the da Vinci Surgical System.

Minimally invasive robotic surgery

The da Vinci Surgical System enables minimally invasive, less traumatic surgery and is typically used in prostatectomies. By performing a robotic prostatectomy, the surgeon utilises finely controlled robotic arms and instruments to do the prostatectomy safely with tiny incisions. This greatly enhances recovery time and the prospect of a positive outcome for the patient.

The da Vinci Surgical System was implemented at Mediclinic Durbanville in 2014 and has made a significant difference to the way prostatectomies are performed.

Treating prostate cancer

After skin cancer, prostate cancer is the most common among men. If detected early, prostate cancer can be treated successfully and survival rates are high, but until recently prostate cancer patients had few options if they needed surgery.

The only option was an open prostatectomy, involving significant surgical incisions, pain and side effects after surgery. The entire prostate could be removed, but the surgery came with a great deal of blood loss, significant pain, the possibility of infection, a longer recovery period and extended hospital stay. It would often lead to a loss of bladder control and erectile dysfunction if the complicated plexus of nerves situated around the prostate was severed.

The ‘robot’

Dr Gawie Bruwer, urologist at Mediclinic Durbanville, is one of only 17 surgeons in South Africa who are accredited to operate using the da Vinci Surgical System. The system is very complex and that means training and accreditation are vital.
Dr Bruwer calls it simply The Robot.

‘The training we underwent prior to performing the first actual surgery was quite intense.

First we all spent between 50 to 60 hours using a simulator. Then we did three days of operating on pigs – 12 of those procedures were done under the supervision of a proctor and then my colleague, Dr van Vollenhoven, and I assisted each other 13 times until we clocked 25 operations. We had to keep our private practices going while doing the training, so it was challenging, but it was worth it,’ says Dr Bruwer.

The da Vinci’s robotic arms are automated but the surgeon still controls every move. The mechanical wrists of the robot mimic the hands of the surgeon in a replica of the traditional invasive surgery, but much more delicately and precisely. It takes away any shakes or jitters that the surgeon might be experiencing.

Dr Bruwer says, ‘You have a magnificent 10 times magnification of the inside of the body, so you can see even the smallest veins and arteries. And you can spot them before they’re visible with the naked eye.

‘Although the da Vinci system has been used in the USA since 2003, technicians were initially not well-trained enough. Proper training was subsequently implemented, including here in South Africa. Thus far we have performed more than 100 robotic prostatectomies at Mediclinic Durbanville,’ Dr Bruwer says.

First patient

In September 2014, Thomas Mouton became the first patient at Mediclinic Durbanville to undergo a da Vinci prostatectomy. He could go home after only two days, he had minimal side effects and to hhdate he is still prostate cancer free.

He says, ‘The surgery took five hours and was done under supervision of an international doctor responsible for the training in South Africa. When I regained consciousness I realised there was a great deal of excitement about the outcome.

‘I was monitored during the night and the following day. I experienced the slightest bit of discomfort due to the catheter, but no pain and bleeding at all. I was released two days later. I could go to the shops and I had a performance with my band the next day!’

Prior to surgery, his PSA score was 8. Since surgery, it has remained at 0 and there is no prostate cancer present.

Mediclinic Southern Africa CEO Koert Pretorius says, ‘We are focused on providing the best possible care for our patients. This includes being at the cutting edge of innovation. The da Vinci Surgical System is one of many examples where our investment in innovation and technology is benefiting our patients.’

Published in Innovation