Robots performing surgeries – future with the Da Vinci Si

He slips his fingers into pincer-like gripping tools and gets to work on his patient. However, the urologist isn’t seated next to the operating table and his hands don’t come into contact with the surgery he is performing.

This scenario may sound incredibly futuristic, but this is the reality created by the Da Vinci Si technology being used at Netcare Waterfall Hospital in Midrand.

“This is the gold standard of care in Europe and the United states,” Haffejee enthuses.

At the moment, the technology is being used for prostatectomies. It was originally created to perform heart surgery.

“We always joke that they started in the heart and ended up in the prostate,” Haffejee says with a smile.

Professor Mohammed Haffejee performs a simulation, 07 July 2014, with the Da Vinci robotic system that the Netcare Waterfall Hospital in Midrand, Johannesburg, has invested in. The robotic system allows the surgeon to operate remotely during highly intricate operations which is less invasive than open surgery. Picture: Alaister Russell

The robot is made up of three components. The first is the robot itself, which has four arms and a camera in the middle. Each arm has the ability to hold a different surgical instrument.

“This is an extension of open surgery, so you could have scissors on one side, and an energy instrument on the other,” says Haffejee.

The next component is the console. This is where the urologist will sit to control the robot. The console has “hands” which can be manipulated with two fingers. They exceed the range of motion of a human wrist, making more intricate work possible. When you consider the fact that the prostate gland is the size of a walnut and is surrounded by muscles, nerves and blood vessels, this is definitely a good thing.

“The main goal with this kind of surgery is to take out the cancer. Your secondary goal is to improve continence, and the third goal is to maintain erectile function. The camera allows us to have three dimensional magnifications,” Haffejee explains. “Patients also have a shorter hospital stay and there is very little blood loss. Typically we would have to transfuse a patient and they would have to spend two days in ICU before going to a general ward. I have performed three live operations and all three patients went home on the second day.”

The robotic arm of the Da Vinci robotic system that the Netcare Waterfall Hospital in Midrand, Johannesburg, has invested in. The robotic system allows the surgeon to operate remotely during highly intricate operations which is less invasive than open surgery. Picture: Alaister Russell

The third component is a CPU, much like the one that you would find in your computer at home.

Some people might be nervous of the technology because it’s new to South Africa. However, while it’s a bit foreign to us, the Da Vinci Si has been used overseas since 2008 and there are currently 2 900 systems operating around the globe. There are also strict measures to ensure patient safety, so that there are no “guinea pigs.”

“The important thing about this technology is that it has a training pathway. You can’t just show up in the morning and say that you want to perform a surgery. Firstly, you have to do an online assessment and pass with 90%. Then you have to work on the system, which has a simulator. You learn things like how to suture and what to do in an emergency. If something does go wrong during an operation we have a live feed back to the Da Vinci technicians.

“You would then go to a wet lab and work on live tissues. Only after this would you be able to work on patients. You don’t start doing solo surgeries – you’d have a proctor, someone with experience, there while you operate,” says Haffejee.

The view through the goggles of the Da Vinci robotic system that the Netcare Waterfall Hospital in Midrand, Johannesburg, has invested in. The robotic system allows the surgeon to operate remotely during highly intricate operations which is less invasive than open surgery. Picture: Alaister Russell

Sitting at the console and working on the simulator feels like you’re playing a very advanced video game. A simple exercise of placing coloured objects into matching containers gives you an idea of how the machine’s “hands work”. The hands pick up your every movement and slightly exaggerate them. Move your head away from the machine’s visor and it freezes – another safety feature.

The obvious question is: will doctors be able to perform operations on patients a continent away?

“The surgeon at the console could certainly be in the room next door. However, a reliable data system would be needed for a doctor to be on another continent. There would have to be a reaction time of less than two seconds,” says Haffejee.