Under the robotic knife

[Image] The functionality of the da Vinci surgical robot is improved by the different heads that can be attached to the flexible arms.
(Image: da Vinci Surgery)

Craig Doonan
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Surgeons have a saying; ‘If you cut you cry.’ It’s an exhortation to them to take special care and time, especially when performing procedures where space is restricted.

Over the past 15 years robotic surgery has developed and evolved as a surgical tool to improve surgical technique in procedures where precision is of the utmost importance. Technology now makes colorectal, gynaecological, urological, cardiac and thoracic procedures less invasive, reducing the risk of complication and speeding up healing time.

Until now South African patients were deprived of these benefits, but with the unveiling of the first da Vinci robotic surgery system in South Africa, surgery has taken a giant leap forward.

At the unveiling at Pretoria’s Urology Hospital on Wednesday, 2 October, Dr Lance Coetzee, senior consultant urologist and chairperson of the Hospitals Research Committee, acknowledged the cutting-edge innovation of the system by joking, “Robotic surgery is not surgery by robot.”

In robotically assisted surgery, the surgeon sits at a console and operates robotic arms that manipulate miniaturised tools inserted into the patient’s body through small incisions. For surgeons, whose expertise is based as much in practice and touch as in training, sitting at a console remotely operating robotic arms is an unfamiliar feeling that requires getting used to. Hence, the R17-million cost of the surgical system covers not just the equipment but the specialist training by skilled surgeons certified in its use.

Dr Coetzee, who is one of just four South African surgeons qualified to use the system, says an added advantage is that it can be used as a training tool. A miniature lighted camera is able to stream the procedure to multiple monitors, allowing the system to be used to up skill surgeons.

“We consider ourselves to be a centre of excellence on the continent; the strict grading system for surgeons was an important consideration for us before we decided to adopt and introduce robotic surgery to South Africa.”


Robotic surgery benefits include less scarring, pain and blood loss; fewer complications, shorter hospital stays and a faster recovery. In tighter spaces the flexible robotic arms can work more precisely than a surgeon so the traditional large incision is no longer necessary.

“The arm mimics the movement of the human wrist so it’s like having a miniature hand inside the abdominal cavity,” Coetzee explained.

For his colleagues, it is the precision of the instruments that makes the system popular.

“For a prostate surgeon working with delicate male organs the precision you can achieve is the system’s major advantage.”

Thomas Dunbar, managing director of medical supply company Earth Medical, says the future of robotic surgery will see medicine moving beyond the limitations of the human hand and eye.

“One day a surgeon will be able to perform surgery without even touching the patient.”

Sarel van der Walt, managing director of the hospital, believed his doctors when they said that robotic surgery would be a godsend but his concerns were costs. Scepticism from medical aids over the technology did not help make his decision easier.

“In the end it came down to this; the technology costs slightly more than conventional surgery but the benefits to patients are multiplied.”

The robot in Pretoria has been christened Mthombo – meaning “pure drinking place by a river” in Zulu. The da Vinci surgery system has been used in over a million operations since it first came on the market 13 years ago and will be used in South Africa for the first time on 21 October.