A small group of Stellenbosch University’s (SU) faculty of medicine and health sciences’ lecturers have been leading the charge in South African public health and tertiary education, by becoming the first organisation in these sectors to start using what is currently seen as the world’s most advanced robotic surgical technology.
This is according to Dr Tim Forgan, robotics coordinator and head of colorectal surgery at Tygerberg Hospital. This surgical division kicked off the use of the “very expensive, cutting-edge” Da Vinci XI technology in late February, stated Forgan.
All of the surgeons who are currently in training to use the Da Vinci XI surgical technology are lecturers at SU’s faculty of medicine and health sciences, according to a media release from the Western Cape Government on 22 February. From left to right: Dr Tim Forgan (colorectal surgeon), Dr Farzana Cassim (urologist), Dr Viju Thomas (gynaecologist), Dr Pieter Spies (urologist) and Dr Paul Ciapparelli, director of clinical services at Tygerberg Hospital. PHOTO: Supplied/Pieter Spies
The technology consists of robotic arms controlled by a surgeon, explained Forgan. While instruments for traditional keyhole surgery can be “clunky” to hold and provide difficult visualisation, Forgan explained that the Da Vinci XI provides higher magnification and can be controlled from the corner of the theatre.
The technology was developed in America and acquired by Tygerberg Hospital in October 2021, according to a media release from the Western Cape Government on 22 February.
The Da Vinci XI surgical system consists of three main components: the patient cart, the vision cart and the surgeon console. GRAPHIC: Connor Cogill
More recently, the technology has been used in the hospital’s urology department, according to Dr Pieter Spies, consultant urologist at Tygerberg Hospital and SU. The technology was used in this department for five radical prostatectomies from 14 to 18 March.
One part of the Da Vinci XI surgical technology is the “patient cart”, which is the robotic arm that works on the patient and translates the movement of the patient, explained Dr Pieter Spies, consultant urologist at Tygerberg Hospital and Stellenbosch University. The technology improves visualisation, significantly decreases the size of the incision, and lessens the chance of a hernia, according to Dr Tim Forgan, robotics coordinator and head of colorectal surgery at Tygerberg Hospital. PHOTO: Supplied/Pieter Spies
Training
Spies had to undergo extensive training to use the technology. This training entailed online courses, 30 to 60 hour simulation exercises, practical learning of how the technology “physically works”, observing cases of the procedure being performed by other surgeons, and assessment at a training centre, he explained.
Spies underwent the final leg of his training in Edinburgh at the Royal College of Surgeons before returning to Tygerberg Hospital, where he performed his first five radical prostatectomies using the technology under the apprenticeship of a proctor.
Dr Pieter Spies, consultant urologist at Tygerberg Hospital and SU, completed the final part of his training to use the Da Vinci XI technology at a training centre at the Edinburgh Royal College of Surgeons. Spies explained that this training is more like an assessment which lasts for one or two days. He added that the training included practising finer techniques on pig models. PHOTO: Supplied/Pieter Spies
“We’ve already learned a lot and cut our procedure time in half,” said Spies. “It’s extremely exciting to be involved with this kind of technology, and it’s a privilege to have that here at Tygerberg and SU,” added Spies.
To be taught by the same innovators being trained to use this technology is “an absolute honour and privilege”, stated Vhuḓi Ravhutsi, chairperson of the Tygerberg Students’ Representative Council.
The Da Vinci XI surgical technology includes the surgeon console (on the left), which the surgeon sits at, usually in the corner of the theatre. The surgeon puts his head halfway into the machine, which provides three-dimensional vision and the ability to control the arms of the robot, explained Dr Pieter Spies, consultant urologist at Tygerberg Hospital and Stellenbosch University. The vision cart (on the right) is where other people in the theatre can see what is going on inside the cavity being operated in. PHOTO: Supplied/Pieter Spies
The future
Regarding the future of robotic surgery in South Africa, Forgan is hopeful that it will become “more the norm than the exception”.
“The long game is to eventually set up a robot training centre at SU, because there currently isn’t one in South Africa,” said Forgan.
“Together with UCT [University of Cape Town] we will become the first training centres or universities [in South Africa] that will be offering robotic surgery training to residents and registrars in the coming years, so we’re very proud of that as well,” stated Spies.