Da vinci surgery: the surgeon’s perspective
Posted on 23 September 2015
The new da Vinci Si HD robotic system is already being hailed as the future of urological surgery. Dr Gawie Bruwer and Dr Pierre van Vollenhoven talk us through system, as they experience from a surgeon’s point of view.
It’s official name is the da Vinci Si HD robotic system. The manufacturers describe it as ‘a sophisticated laparoscopic surgical tool that will be used for urological procedures and radical prostatectomies’. To Dr Gawie Bruwer and Dr Pierre van Vollenhoven, it’s simply ‘The Robot’.
Here’s how it works: the Robot (we’ll call it that, too) has mechanical wrists that bend and turn to mimic the movements of a surgeon’s hands during surgery. As the surgeon controls it, the Robot operates on the patient, translating the surgeon’s hand movements into smaller, more precise movements. ‘The system works the same way on the inside of the patient as open surgery,’ Dr Bruwer explains. ‘The movement of the Robot’s arms inside the patient’s body is a precise replica of what you as the surgeon do on the outside with your arms, but the movement is five to ten times smaller on the inside. That’s very good in that it takes away any jitter or stutter that the surgeon might have. You have a magnificent 10-times magnification of the inside of the body, so you can see even the smallest veins and arteries, which can can see long before you’d see them with the naked eye.’
Dr Bruwer is a urologist at Mediclinic Durbanville. Dr Pierre van Vollenhoven, a urologist at Mediclinic Panorama. Together, they are the only two surgeons in South Africa who are accredited to use the system. That accreditation is absolutely vital, because of the system’s incredible complexity.’It’s a lot of work for the surgeon to master it,’ Dr Bruwer points out. “It’s not something where you just pick up the technique and off you go.’ Dr Van Vollenhoven agrees. ‘As a surgeon, it’s a massive challenge to get to a place where you can start operating with the Robot,’ he says. ‘It’s a massive learning curve.’
Both doctors clocked about 50 hours of training learning how to use the system. Dr Van Vollenhoven describes spending two days in Belgium getting to grips with the system.’After that you’re in the wet lab, operating on pigs… and then you have to attend cases with a proctor, where each case takes about five hours. So that’s 40 hours, plus another 50, plus about another 20… It’s a lot of time you have to put in!’
Time… and sacrifice. Both doctors still had to continue running their own practices while mastering The Robot on their own time. ‘Of course I don’t mind that,’ says Dr Bruwer, ‘because it is a blessing to be able to treat patients with something so magnificent, and with the results that we’re getting.’
From the patient’s point of view, those results include much faster and much more comfortable recovery. But when you look at the surgery from where the surgeon is sitting, you really get an appreciation of why Dr Bruwer and Dr Van Vollenhoven are so excited about The Robot.
We spoke to the doctors straight after they’d come out of theatre using the Robot in surgery. ‘We were done after four hours,’ Dr Van Vollenhoven told us. ‘In open surgery that same operation would usually take about three hours in theatre, with half an hour of preparation and about two hours of operating time. So it’s an hour extra with the Robot. One of the reasons for that is you spend a lot of time preparing the patient. You have to just about wrap them in cotton wool, because of the pressure areas – the patient lies in a difficult position for quite a long time. Then you have to connect the Robot, put the laparoscopic ports in, connect the Robot to the ports, make sure it’s all safe and working, and only then can you start operating. That preparation alone takes about 45 minutes.’
But – as Dr Van Vollenhoven points out – while the operation may take longer, you have precision surgery… and quicker recovery. No wonder, then, that Dr Bruwer calls it ‘the cutting edge of treatment when it comes to significant, aggressive prostate cancer – now, and for many years to come.’
The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.