Robotic-assisted cardiothoracic surgery comes to SA

In a first for the continent, a cardiothoracic robotic-assisted surgery programme has been established at Netcare Christiaan Barnard Hospital in Cape Town to provide less invasive alternatives for procedures involving the chest cavity, including lung cancer and cardiac surgery.

Cardiovascular and thoracic surgeon Dr Johan van der Merwe is leading the programme and recently performed the first cardiothoracic procedure using the da Vinci robotic surgical system at the hospital, Netcare said on Monday.

Visiting UK cardiothoracic surgeon and lung cancer specialist Dr Joel Dunning, of James Cook University Hospital in Middlesbrough, UK, 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.

“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. This will allow more patients to receive state of the art, world class, evidence- based treatments,” Van der Merwe said.

Dunning said many cardiothoracic procedures traditionally involved either splitting the breastbone to access the area for open surgery or thoracotomy, where the chest is opened through the rib cage.

“This necessitates a lengthy recovery period, often with significant discomfort for the patient.

“The use of robotics technology, however, allows intricate procedures to be performed deep within the patient's chest without the need for large incisions, splitting of the sternum or opening the chest through the rib cage,” Dunning  said.

Netcare said Van der Merwe operated using the da Vinci robotic console as an extension of his fingers and hands, enabling the intricate operation to be performed much less invasively through small punctures in the patient's chest while having excellent 3D and magnified vision.

The first patient to undergo a robotic assisted thoracic procedure in Africa was Etienne Nel, a former semi-professional electronic sports (esports) gamer.

Nel first noticed pain around his shoulder four years ago. As time went by he began feeling discomfort and “pins and needles” in his right arm and hand.

He was eventually diagnosed with thoracic outlet syndrome and by this time this had begun to restrict movement in his right arm.

Nel found Van der Merwe who discussed the options available to him.

Van der Merwe said the nerves and blood vessels to Nel's right arm were pinched between his first right rib and his collarbone, impeding sensation, motion and also drainage of blood from his arm.

“Instead of cutting above his collarbone through sensitive muscles, operating with this minimally invasive technology allowed us to gently remove the top rib on the right hand side to relieve the compression of the nerves,” Van der Merwe said.

Nel was ready to be discharged the day after the landmark procedure at the hospital and said he had already regained a good range of movement on the first day after the operation.

“I could feel the punctures where the robotic system's instruments entered my body, but the recovery is going even better than I expected. I am already able to get out of bed and use my computer,” Nel said four days after having his rib removed.

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