Enhancing urogynaecology with robotics

Posted on 29 May 2023

An award-winning urogynaecologist and South Africa’s first female robot-assisted surgeon has joined Mediclinic Panorama.

Dr Farzana Cassim recently opened a private urology and urogynaecology practice at Mediclinic Panorama. In 2022, Dr Cassim was one of eight doctors selected to receive training on the da Vinci surgical robotic system at Tygerberg Hospital. That same year, she also won the Karl Storz Golden Endoscope Award for outstanding achievements in urology. Now she can offer urogynaecology patients her expertise, including the use of the da Vinci robotic surgical system at Mediclinic Durbanville.

In joining Mediclinic Panorama, Dr Cassim has become one of two urogynaecologists at the hospital. She says she was drawn to medicine, and surgery especially, when she realised she could make a difference in people’s lives by solving their medical problems relatively quickly. She became passionate about urology due to its diversity; from prostate and urinary problems to paediatrics, cancer, and kidney stones.

What is urogynaecology?

Urogynaecology combines urology and gynaecology, focusing on the female pelvic floor and problems of the bladder, uterus, and vagina. “This is a relatively new area of sub-specialisation in South Africa, Dr Cassim explains. “It addresses anatomical and functional problems that occur together and are interlinked. For example, pain and muscle spasms (anatomical) can affect urine flow (functional).” Urogynaecologists see patients with urinary dysfunction (incontinence or inability to urinate, for example), as well as anatomical issues of prolapse of the bladder, bowel or uterus.

The benefits of robotic surgery

Robotic-assisted laparoscopy offers benefits to patients and surgeons alike. It enables surgeons to perform complex and delicate operations, such as urogynaecological surgery. Robotic procedures are generally quicker and less invasive than traditional open or laparoscopic (keyhole) surgery. The recovery process from robotic-assisted surgery is also generally faster compared to other types of surgery because it’s less traumatic on the tissues, Dr Cassim explains.

“Robotic-assisted surgery has transformed urogynaecology, making operative times much shorter. The blood loss during surgery is generally less, as is the [need for] analgesia (pain medicine). Patients can generally be discharged a day after the operation, compared to staying in hospital for up to five days for an open hysterectomy and a sacrocolpopexy (pelvic organ prolapse), for example.”

How it works

Robotic-assisted surgery involves a robotic system controlled by a surgeon. The surgeon makes small cuts in the patient’s abdomen and inserts the instruments, including a 3D camera, which are attached to robotic arms. The surgeon performs the surgery through a console, directing the robot’s movement.

“Robotic surgical instruments are much finer than those used in standard laparoscopy, meaning there is more mobility to get around corners and into small spaces,” says Dr Cassim.“Controlling robotic instruments is very intuitive. They also have more joints, making them almost like extensions of the surgeon’s hands and fingers. The magnification with robotic-assisted surgery is 10 times normal vision in a 3D view, whereas most laparoscopy is four times magnification in a 2D view.”
Dr Cassim says not everyone is a candidate for laparoscopic or robotic-assisted surgery, as it depends on the individual patient’s medical and physical conditions.

Are robots the future of medicine?

“While there will always be enhancements to the da Vinci system, robots aren’t replacing surgeons just yet,” says Dr Cassim. “You will always need the surgeon’s insight and their presence in case of complications. The robot doesn’t do the operation; rather it assists the surgeon.”

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