The technology has also been used successfully internationally and by robotic surgeons at Netcare in surgery for bladder and kidney cancers.
Firsts in South Africa represent important milestones in advancing local medicine
First radical and partial nephrectomies with aid of robotic-assisted technology a complete success
In April 2015, the state-of-the-art da Vinci Si robotic technology was used for the first time in South Africa in the surgical removal of the patient's cancerous kidney, a procedure known as a radical nephrectomy. The surgery took place at Netcare Waterfall City Hospital in Midrand, and the patient was discharged home a mere three days later where he was able to quietly celebrate his 51st birthday with his family.
The highly complex operation was successfully completed through small incisions in the skin, according to Dr Marius Conradie, a urologist and robotic surgeon who practises at the hospital and who performed the surgery with the assistance of a team of specialists and nursing staff.
Dr Conradie said the patient's right kidney, which was badly diseased, was removed. Despite the fact that a nephrectomy is a major procedure, the patient had recovered to the extent that he was transferred from intensive care to a general ward and had regained his mobility just 24 hours after the operation. With traditional open surgery we expect a patient to take about a week to get back on his or her feet."
"The use of this robotic technology in this specific procedure is an important milestone in the field of urology in South Africa. It was a great honour to have been able to, for the first time on our continent, assist a patient with cutting-edge treatment that has been proven internationally for its effectiveness," Dr Conradie said at the time.
The da Vinci system consists of a surgeon's console offering a screen with 3-D, high-definition display which gives the surgeon excellent magnified vision of the kidney, blood vessels and surrounding tissue during the procedure to enable removal of any diseased tissue with great accuracy. This means that side effects are kept to a minimum and cancer control is improved.
The surgeon uses foot pedals and hand controls to remotely operate the surgical instruments attached to four robotic arms on a second console at the operating table. Unlike traditional surgery, da Vinci robotic-assisted procedures are minimally invasive as the instruments are inserted through small incisions. The robotic arms do the cutting, clamping and cauterising with far greater flexibility and precision than is possible with human hands.
The robotic procedure has many advantages over traditional surgical techniques and enables the surgeon to perform the procedure in a minimally invasive manner with an extremely high degree of accuracy.
The smaller incisions required mean that the patient suffers reduced blood loss during surgery and that there is a lower risk of wound infection. In addition, da Vinci patients usually have less post-operative pain and are able to return to their lives much sooner than they would after open surgery," said Dr Conradie.
Dr Conradie explained that surgery is the main treatment for most kidney cancers and may involve the removal of only the diseased part of the kidney, which is known as a partial nephrectomy, or it may require a radical nephrectomy, the complete removal of the organ. In this particular case the disease had advanced to the stage that the entire kidney had to be removed.
In another first in November 2015, a 29-year-old woman from Springs became the first person in South Africa to undergo a partial nephrectomy using da Vinci robotic-assisted technology, and also the first woman in South Africa to undergo surgery using this technology. The organ-preserving excision of a cancerous tumour from her kidney, was also performed by Dr Conradie at Netcare Waterfall City Hospital.
Dr Conradie said that doing a partial nephrectomy was an extremely intricate and exacting procedure as there are a number of blood vessels involved in the reconstruction of the urinary tract, and any mistake could lead to the patient bleeding to death on the operating table.
The patient's tumour was diagnosed after an ovarian cyst burst. It had gone undetected as she had not been seeing her gynaecologist regularly. The golf ball-sized mass in her right kidney was incidentally discovered during an ultrasound examination by her gynaecologist.
During the surgery Dr Conradie used an ultrasound probe to determine the extent of the tumour, to make sure they remove all of it. It was an 'angry red thing', about 4cm long, on top of the kidney, which he successfully excised. According to him, the success rate of da Vinci procedures was much higher and recovery time much shorter compared to traditional surgery. The procedure itself was also faster.
Gouws spent a day in high care and was thereafter transferred to a general ward for two days, after which she was discharged from hospital.