Dr Gawie Bruwer performs 500th robotic radical prostatectomy

Posted on 21 July 2020

Since it was introduced to Mediclinic Durbanville in 2014, the da Vinci Surgical System has helped 500 patients requiring surgery to treat cases of prostate cancer – and many more.

“I had two patients who were due for surgery just before the lockdown took effect, and when it was announced that they couldn’t fly, I suggested that they travel together. And that’s how they got here: they drove together, all the way from Durban.”

Dr Gawie Bruwer is a urologist at Mediclinic Durbanville with a special interest in using minimally invasive and microscopic surgical techniques to treat patients with advanced cases of prostate cancer. Since 2014, he has been using the da Vinci Surgical System to perfect this surgery – and recently helped his 500th patient.

Prostate cancer is alarmingly prevalent, both locally and all over the world. This is a condition that affects one in every 19 South African men, according to the National Cancer Registry, making it the most common form of the disease for men in SA.

The prostate is a small gland located just below the bladder, and part of the male reproductive system. Cancer of the prostate often forms gradually and may not present any symptoms until fairly advanced. Once signs do develop – including changes in urination patterns, such as a marked increase in the passing of urine, a weak or interrupted urinary stream, or a painful or burning sensation during urination or ejaculation – the only treatment option is surgery to remove the gland.

This is where the da Vinci Surgical System is beneficial, explains Dr Bruwer. “This system is the global gold standard for this kind of surgery,” he says, “but there are only five in the country. So we have patients travelling in from other provinces so they can benefit from this technology.”

A radical prostatectomy involves removing the entire prostate gland and some tissues – including the seminal vesicles and some lymph nodes – surrounding it. Whereas an open surgical technique would require a 9cm incision, a few days’ hospital stay and a significant period of recovery, the robotic approach offers several key refinements.

“Usually, patients who have open surgery will require a catheter for 18 days, and need six weeks to recover before they can go back to work,” explains Dr Bruwer, “whereas our patients use the catheter for a week, and resume their normal daily lives after one or two weeks off their feet.”

The da Vinci Surgical System offers surgeons greater surgical precision, and increased range of motion, improved dexterity, enhanced visualisation of the operation area, and improved access inside the body – which helps doctors spare healthy tissue that is not impacted by the cancer.

For patients, post-operative bleeding and associated pain is also remarkably less than the open surgical alternative, says Dr Bruwer. “We are able to track our patients from the day they are referred to their final follow-up consultation,” he says. “We look at everything from clinical results, like when they are able to regain functional urinary continence, to patient experience – how satisfied were they with the surgery and the aftermath? Overall, these results are far, far better for our robotic surgery patients.”

Tracking the patient journey in this way also empowers the hospital to carefully monitor the cost of a procedure, for the patient. “In this way we are able to prove to funders the ways in which this robotic technology has a major cost-saving benefit, for all involved.”