In what is claimed to be a first for Africa, a cardiothoracic robotic-assisted surgery programme has been established at the Netcare Christiaan Barnard Hospital in Cape Town.
It will provide less invasive alternatives for procedures involving the chest cavity, such as lung cancer and cardiac surgeries.
The programme is spearheaded by Dr Johan van der Merwe, a “minimally invasive and hybrid cardiovascular and thoracic surgeon”, who learned about robotic techniques during six years of training in the UK and Belgium, and completed intensive training on the da Vinci robotic surgical system.
He recently performed the first cardiothoracic procedure using the da Vinci system at the Netcare hospital.
Visiting UK cardiothoracic surgeon and lung cancer specialist Dr Joel Dunning of James Cook University Hospital, in England, oversaw the procedure to remove a rib in a thoracic outlet decompression surgery in a 33-year-old man for the relief of pain and restricted movement in his right arm.
Dr Van der Merwe says: “We are grateful for the opportunity to establish this platform, which will enable our cardiac and thoracic surgery colleagues across the country and elsewhere in the continent to provide robotic surgery as an option to their patients.”
Internationally, lung cancer surgery is one of the most common applications of robotic technology in thoracic surgery, as these patients tend to be older and frail, and therefore need a more delicate, less invasive approach, according to a Netcare statement.
Dr Dunning says many cardiothoracic procedures traditionally involve either a sternotomy, or splitting of the breastbone to access the chest cavity for open surgery, or a thoracotomy, where the chest is opened through the rib cage.
“This necessitates a lengthy recovery period, often with significant discomfort for the patient,” he adds. The use of robotics technology, however, allows for intricate procedures to be performed deep within a patient’s chest without the need for large incisions, or either of these methods.
Instead, Dr Van der Merwe operates using the da Vinci robotic console as an extension of his fingers and hands, enabling the intricate operation to be performed far less invasively through small punctures in the patient’s chest while having excellent 3D and magnified vision, explains Netcare.
Dr Van der Merwe says the da Vinci technology gives the surgeon a greater range of movement and steadiness of hand during surgery, which is particularly important in intricate and complex procedures.
“It is important to note the robotic technology is not able to do anything on its own. Rather it is a tool fully controlled by the skilled surgical team at all times.”
According to Dr Dunning, international studies indicate a robotic approach to cardiac and thoracic procedures also tends to offer quicker recovery times on average when compared with open surgery.
“Typically, patients having traditional open surgery for lung cancer would need to spend five days in hospital and may be unable to drive for a month or more. Whereas, with robotic-assisted thoracic procedures, the patient’s recovery time is usually much shorter, with only two to three days in hospital and, in many cases, the person is able to drive and return to work as soon as the following week.”
Dr Dunning believes that establishing cardiothoracic robotic surgery is a significant development for cardiology patients, as it has applications such as single or multiple vessel coronary bypasses, in combination with cardiac stents as a hybrid coronary artery procedure.
“In coronary artery revascularisation, for example, the da Vinci robotic system can be used to harvest internal mammary artery conduits, after which the bypass operation is performed minimally invasively through a small incision. The remainder of the procedure is completed with stents.”
Dr Van der Merwe adds the cardiothoracic robotic surgery centre at Netcare Christiaan Barnard Hospital has evolved through efficient teamwork and ongoing international collaboration and mentoring.
Through this technology, experts such as Dr Dunning can participate in an operation from abroad, while having full visuals of the theatre setup, the robotic components, and the operative field in real-time, notes Netcare.
“This allows us to further develop our skills and build our local programme to bring the advantages of global developments in cardiac and thoracic surgery robotics to patients from South Africa and beyond our borders,” Dr Van der Merwe concludes.
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