Mediclinic Durbanville performs South Africa’s first multi-organ robotic surgery

Two surgeons at Mediclinic Durbanville performed South Africa’s first complex multi-organ robotic surgery, using the Da Vinci system to remove a patient’s colon and bladder simultaneously, treating multiple cancers in a single procedure.

How robotic surgery improves outcomes in colon and bladder operations

Gastroenterologist Dr Jaco Botes and urologist Dr Gawie Bruwer were the highly skilled surgeons who performed the groundbreaking multi-organ robotic surgery at Mediclinic Durbanville.

Robotic surgery is a type of minimally invasive, or keyhole, surgery, explains Dr Botes. It allows surgeons to complete larger, more complex procedures with greater precision and smaller incisions, often avoiding open surgery. The system’s 3D magnified vision helps surgeons spot nerves they might otherwise damage, while robotic arms with articulated “elbows” enable intricate work in tight spaces.

“This makes the dissection of blood vessels and nerves much safer than normal laparoscopic colonic surgery,” Dr Botes adds. “Open surgery would have achieved the same result in getting the cancers out successfully, but with robotic surgery patients have less pain, go home earlier, have fewer nerve injuries and return to normal function faster.”

Dr Bruwer explains that a cystectomy – the surgical removal of the bladder – is the largest operation in urology and can involve multiple complications. “We began performing cystectomies robotically about two years ago,” he says, and has since become a leading expert in this field. Despite the high cost of instruments, robotic cystectomies have proven highly effective, offering the same recovery benefits seen with robotic prostatectomies, which have been performed in South Africa since 2013.

“Based on over 35 robotic cystectomies we’ve performed, we’ve seen a remarkable difference. Our average patient stay is half the time required with open surgery,” Dr Bruwer says. “Patients go straight to the ward instead of ICU, which is standard with open cystectomies. Patient recovery and aftercare is also improved.”

Tackling dual cancers simultaneously

The 66-year-old patient who received the lifesaving surgery had dual cancers – primary cancer of the bladder and primary cancer of the colon. The colon cancer was an adenocarcinoma, Dr Bruwer explains, a type of cancer that starts in the glands that line the organs.

“This had a completely different origin than the bladder carcinoma, which was a very aggressive, superficial bladder cancer that didn't react to chemotherapy or resections. We know it has a high chance of becoming infiltrative, in other words, spreading into the surrounding tissue.” The best treatment for both cancers was the removal of both affected organs.

Because patients rarely have both cancers at the same time, the procedure was especially unique. Performing the surgeries robotically – and at the same time – was crucial. “It’s impossible to do open removal of the colon, and then at a later stage, take out the bladder, or vice versa,” Dr Bruwer explains. The fact that both surgeons were trained in robotic surgery and worked well together was key. Without these factors, the simultaneous robotic procedures likely wouldn’t have been possible.

“What sets Mediclinic Durbanville apart is that, as a group of doctors, we work exceptionally well together,” says Dr Bruwer. “We bring together highly specialised fields and the best technology in one place, setting the bar for surgical excellence worldwide,” adds Dr Botes.

The operation

The doctors worked together during the nine-hour operation, setting a new benchmark for collaborative care.

First, Dr Botes removed the entire right colon, including the caecum with its blood supply and the lymph nodes that drain it, while carefully preserving the blood supply to the ileum (the last part of the small intestine) for Dr Bruwer to use later. He then performed an anastomosis, surgically connecting the remaining small intestine to the transverse colon, restoring continuity so the intestine could function normally.

“When we started performing the cystectomy,” Dr Bruwer explains, “we already had the ileum stapled and ready for the urine stoma.” They carried out a standard robotic cystectomy, removing the surrounding lymph nodes, then connected the ureters (kidney tubes) to the ileum and brought the other end of that segment to the surface of the abdomen to create the stoma, allowing urine to pass out of the body.

The operation was a success, with both cancers completely removed. The patient was moved to a regular ward immediately afterwards. “He had a normal blood count and never required a blood transfusion, which is often needed in open surgery,” Dr Bruwer says. “Due to the magnitude of the operation, we fed him slowly and took a conservative approach.”

Despite this, he was up and moving the next day and received regular physiotherapy during his seven-day hospital stay. By the time he went home, he could walk and drive normally. Thanks to the robot, the largest incision – needed only to remove the bladder and bowel –was still relatively small.

The combination of performing such a complex operation through small incisions and the patient’s rapid recovery is what truly sets robotic surgery apart.