Click here to read the full article
 
According to the National Cancer Registry, prostate cancer is the most common cancer in black South African men, and the second most common in white South African men. Traditional surgery to remove cancerous prostates involves long recovery time, much pain and blood loss, and has potential implications such as impotency and incontinence. These problems are caused by the sensitive and difficult nature of the procedure, and result in many men opting out of the surgery.

The Da Vinci Surgical System is a robotic tool which aids in increasing precision and decreasing risk during prostatectomies. It first landed in South Africa two years ago. The Urology Hospital in Pretoria was the first to acquire the $20-milllon robot, and today there are three others in the country. Since 2013 more than 700 surgeries have taken place using the system, of which roughly 400 were done at the Urology Hospital. Systems such as this are being developed and will eventually be used commonly in other surgeries involving kidneys, pelvic floor and other delicate and hard-to-reach areas of the human body. The Urology Hospital is performed its first partial nephrectomy (partial removal of cancerous kidney) in November, taking South Africa another step forward in advancing its cancer treatment options.

 

Surgical robotic tools make use of small robotic arms with various instruments on the ends, including clamps and surgical scissors in varying sizes. These instruments are inserted through small incisions in the body, and have "wrists" that enable them to move extensively. This is called EndoWrist technology and provides far more dexterity than human wrists. This makes it easier to achieve precision and to get around the many nerves surrounding the prostate gland, in turn decreasing the risk of nerve damage and the resulting consequences.

These instruments are operated through a console placed a few metres from the operating table. The surgeon uses highly sensitive joystick-type controls to move the surgical instruments. The console smoothens the surgeon's hand movements, and makes them smaller and more precise. This enables the surgeon to move around the nerves delicately, and gently detach them from the prostate. The gland is then inserted into a small capsule and removed from the body through one of the initial incisions.

In order to do this procedure smoothly, the surgeon needs to have a clear image of what is going on inside the body. The system provides the surgeon with a magnified, 3D high-definition view of what is happening inside the patient. This view stays clear because the body cavity is inflated with carbon dioxide. The body stays inflated through the use of air seals at each of the incision sites. 

Naturally, one question asked often by patients is "what happens if the power goes out?" Quite simply, backup generators kick in and things proceed as normal. However, a more concerning event would be a system crash. To ensure fast response and recovery, the system is linked up to one of the manufacture's sites in Germany. 

If something goes wrong it is immediately reported and analysed. If the problem cannot be fixed there and then, the surgeon has to finish the surgery through manual laparoscopy. Any spare parts that are needed can be shipped from Germany within days, and there is minimal disruption in the hospital's surgical schedule. However, an event like this is a rare occurrence as the machine undergoes constant maintenance to the tune of R1-million a year... (more)