SA’s youngest robotic surgeon explains the benefits of technology

Posted on 22 May 2018

There are five da Vinci surgical systems in South Africa and 24 accredited surgeons. Dr Dries Van Den Heever, 38, is the youngest urologist in South Africa accredited to use this advanced piece of robotic equipment.

What are the advantages of using the da Vinci for robotic prostatectomies?

‘It’s a minimally invasive procedure with significantly less blood loss, a much shorter hospital stay, much quicker return to general function and potency,’ says Dr Van Den Heever who has a Paarl-based practice and operates from Mediclinic Durbanville. ‘Plus the incontinence rate is much better compared to the traditional techniques.’

Dr Van Den Heever adds that, as a surgeon, he has the advantage of magnified, three-dimensional vision, articulation of the Endowrist instruments (these are modelled on the human wrist and offer a greater range of motion than the human hand) and a comfortable and ergonomic surgical position.

What else can the da Vinci robotic system do?

‘It’s a very versatile system. I perform only prostatectomies with the system, but some urologists perform partial nephrectomies as well. This is kidney surgery where you remove only the tumour in the kidney and not the entire kidney. It’s also used for a type of congenital abnormality called PUJ obstruction (an obstruction of the outflow of urine from the kidney toward the ureter). And then there are numerous pelvic floor and colon procedures that use the da Vinci as well which fall outside my field of specialisation.’

How is quality control ensured?

‘You have to be accredited in each type of procedure you perform using the da Vinci surgical system. In order to become accredited you have to train under an international proctor and then complete several surgical simulations,’ says Dr Van Den Heever. ‘In addition, you always have an assistant when doing traditional laparoscopic work. If you have another robotic surgeon alongside you, even better, as you can always improve your approach together.’

Are there any disadvantages?

‘The whole process takes a little bit longer. There’s a lot more preparation in theatre to get the patient in position and ensuring their safety while docking the robot. As a surgeon, you become much faster with experience and when you consider the multiple benefits to the patient, the faster recovery and shorter hospital stay, it’s really worth it.

How are patients selected for the surgery?

‘Patients are normally referred from their GPs after their routine prostate exams. Generally, if patients are candidates for radical surgery, the da Vinci system will be the preferred option due to the multiple benefits associated with this system.’ Dr Van Den Heever adds that although his patients are normally older, they aren’t resistant to the technology. ‘Once they’ve seen the technology in action on video, they want the surgery’.