Robotic surgery offers hope to millions in Africa

October 20, 2014

Few days ago, I had a chance to share a cup of coffee with a team of robotic surgery experts involved in ambitious projects for use of robotic hands to perform operations on internal organs in Africa. So far, it has shown promises to benefit patients and surgeons alike, but the high capital outlay and cost of maintenance means very few hospitals can provide it in Africa, world’s poorest continent. In the project which am also involved, the system allows surgeons to perform an operation remotely from a console, controlling a patient-side cart with four interactive robotic arms, a high-performance vision system. In Africa, the experts expects robotic surgery method to be used in surgical procedures for prostate cancer, kidney cancer, bladder cancer, bladder-vagina fistula and kidney pelvis obstruction according to the urologist in charge of the project. Hopefully,your blogger expects the method to mark a breakthrough for prostate cancer surgery in particular. Research has shown that prostate cancer can either be treated through radiotherapy or radical surgery, involving the surgical removal of the cancer but the latter option, has been the method of choice for the last three decades, giving the best cure rates of up to 90 percent. The 3D imagery has provided African doctor’s console that makes the surgery safer, whereas there are other instruments that mimic very accurately the movement of the surgeon’s hands since they move like the human wrist and have superior stitching ability.

For the first time in Africa, doctors can now be remote from the patient.The application of robotic surgery for head, neck and thyroid surgery, however, has been slower because of the constraints of working within the limited space in the head and neck region.Its development has led to the indirect approach of performing robotic thyroidectomy surgery, with access to the thyroid glands gained by making a 5-centimeter incision in the right armpit instead of through the neck, leaving no scars on the neck as with conventional surgery.However, according to the data I have perused, the surgery is limited by the narrow male pelvis and non-watertight anastomosis of the bladder and urethra. Africa’s biggest problem is prostatectomy surgery especially bleeding during surgery where the blood transfusion rates for such surgeries are very high. Laparoscopic, or minimally invasive surgery has become popular in Africa over the past decade. However, African urologists keen to adopt it found the learning curve steep, with limited movements when using the “chopstick” instruments, resulting in high surgeon fatigue. The first robotic prostatectomy was performed fourteen years ago, providing six degrees of freedom for surgeons as it enabled them to sit in an ergonomically designed console away from the patients while a team assisted the patient on the operating table. Robotic surgery will allows surgeons to take a toilet or coffee break while operating.The main challenge for robotic surgery experts in Africa is that most devices available in the market were designed for operating on the non African physique, “attaching the robotic arms can be challenging for African-sized men and women.” As for the patient who undergoes a robotic prostatectomy surgery, there has been less blood loss according to a study conducted by one of medical equipment supplier in Africa where patients can also have a faster return to their regular activities.

Ninety percent of patients in Africa who have had robotic surgery are satisfied and the method has made it easier for surgeons to adopt because of its gentler learning curve to become familiar with the instrument and faster operating times. In one case in South Africa, surgeons were able to surgically remove the thyroid nodule that was located in the lower central neck without any incision on the neck, as access was gained through the armpit and the patient was discharged from hospital the next day and now has a completely normal voice which is a success for any thyroid operation. Other gynaecological operations that the robotic surgery can perform are hysterectomy, or removal of a diseased uterus, ovarian cystectomy, or removal of cysts in the ovary, and correcting in-born abnormalities in the uterus or scarring that causes miscarriages. The robots can be used to repair and reconstruct uterine defects to minimise the risk of miscarriages. To keep the instruments sterile, the plastic drapes over the robotic hands are changed for every operation, according to one of the experts. However, the instruments that do all the organ and tissue cutting and stitching can be sterilised for ten uses before they need to be changed over to a completely new set. The machine can also be used to perform two prostate surgeries in a day, since it requires a lot of time for its preparation.Indeed, African patients that have for long suffered due to inadequate number of surgeons, technology will definitely offer them as smile.

Contador Harrison