A team of surgical specialists from Tygerberg Hospital and Stellenbosch University’s (SU) Faculty of Medicine and Health Sciences (FMHS) successfully carried out a pioneering first robot-assisted total hysterectomy procedure in South Africa.
Using the Da Vinci robot system, recently acquired by Tygerberg Hospital, the team successfully performed the minimally invasive procedure on six patients. The robot system brings hope to the thousands of women who require hysterectomies and other gynaecological surgeries every year, including cancer patients. The surgeons involved in the procedure said the procedure was not complicated, adding that all six patients were discharged within 48 hours and made good recoveries with positive outcomes.
“The Da Vinci system offers the ability to see the area to be operated in 3D and with fluorescent technology, which further enhances the surgeon’s ability to define anatomical structures and abnormalities. The fluorescent technology enables us to inject a marker to map the pathway in which a malignancy may spread and enables us to offer more targeted treatment with fewer side effects,” said Dr Barnard.
Advanced laparoscopic skills
The first three robotic hysterectomies in South Africa were performed by Dr Viju Thomas, head of the FMHS’ Minimal Access Gynaecological Surgery (MAGS) programme, with the assistance of Dr Annelize Barnard, an accomplished endoscopic surgeon and a MAGS fellow, as well as Dr Tik Shan Cheung, a recent graduate. Both Thomas and Barnard both possess advanced laparoscopic skills and were elected by the Department of Obstetrics and Gynaecology to undergo the rigorous training for Tygerberg Hospital’s robotic programme. The training will deepen and expand their surgical repertoire to perform procedures that are currently limited by the technical aspects of conventional laparoscopy.
At the forefront of development
In addition, the duo had to complete many hours of simulator training to familiarise themselves with the robotic system. This was followed by technical training at Tygerberg and the ORSI Academy in Belgium, a high-technology centre for surgical innovation and expertise. The procedures they performed at Tygerberg Hospital were conducted under the supervision of Dr Thomas Herbert, a French robotic surgeon.
Although they opted to start their robotic training in the field of hysterectomies, it is envisaged this will eventually be used in more advanced procedures such as endometriosis and the dissection of lymph nodes to check for signs of cancer. Dr Barnard said the success of the procedure puts Tygerberg Hospital and SU firmly at the forefront of the development of gynaecological robotic surgery in South Africa.
Dr Barnard said minimally invasive surgery (MIS) is well known to offer better outcomes for patients with regard to postoperative pain, scarring, length of hospital stay including recovery time. Some procedures are also better performed with MIS, as the technique offers magnified vision and enables more meticulous dissection techniques, added Dr Barnard. But he said MIS has its own limitations such as the long time it takes to perform a procedure. “Conventional MIS is limited by the long time it takes surgeons to become proficient in the technique, as well as the inherent limitation of working with long instruments with a limited range of motion. Robotic surgery enables the surgeon to adopt more natural hand movements to manipulate instruments. It is therefore easier to perform complex actions and access hard-to-reach areas,” said Dr Bernard.
Dr Bernard said even though open hysterectomy procedures still play a role in some instances, MIS has become the mainstay of hysterectomy in many parts of the world, and that laparoscopic hysterectomies have been common in South Africa for many years. She also highlighted the significance of robotics facilities. She explained that factors that will ordinarily prolong laparoscopic surgery such as obesity, complicated pathology, gynaecological malignancy or endometriosis, would be a thing of the past, thanks to the latest Da Vinci technologies.
Huge step forward
Dr Barnard said having the technical ability to offer MIS to women who would otherwise not have had access to this option is a huge step forward. Said Dr Barnard: “There is no argument that robotic surgery is here to stay, and we will probably see many advances in this field in the future. It is an amazing opportunity to be at the forefront of local gynaecological robotic development.”