ROBOTIC REVOLUTION
Hospital’s surgical success
Major surgery is not something new to Chuchart Pinjai, a 63-year-old retired policeman from Phayao province, but it’s not something he wants to go through again. He had heart surgery in 2015 at Maharaj Nakorn Chiang Mai Hospital and it took him months to get over the pain and return to a normal routine.
He went back to the hospital earlier this year because he had stomach pain. It turned out that he had appendicitis and needed immediate surgery to remove his appendix. While the doctor was operating, he found that Mr Chuchart also had an aortic aneurysm, which can be a lifethreatening condition.
“The doctor explained that if a blood vessel burst in my stomach, I could die from it. So he asked me to come back for more surgery once my body had fully recovered from appendicitis. I didn’t really want to do it as going through surgery is not fun. Not only it is painful but it also means I cannot move my body easily for a long time,” Mr Chuchart said.
The doctor told Mr Chuchart that the surgery was critical and the only way to treat his symptoms. However, he had a new way to make such complicated surgery less painful and need less recovery time — robotic technology.
The operation was successful. Mr Chuchart had less pain and could walk immediately after surgery. He is one of 10 patients to have operations in the new Hybrid Operating Room (OR) that Chiang Mai University installed for its hospital to use as part of its research centre. It is the first hospital in the Asean region to have this type of technology, which could elevate the university and the hospital to compete at international level.
FIRST TO USE
Chiang Mai University is one of many university hospitals in Thailand that have adopted new technology. After installing Davinci robotic arms four years ago, the university started to see how such high technology could help people and save their lives.
Dr Bannakij Lojanapiwat, dean of the faculty of medicine at the university, decided to invest in the Hybrid OR for the university to use.
A Hybrid OR is a surgical theatre equipped with an advanced medical imaging device that guides the surgeon during minimally invasive procedures with 2D and 3D images and enables him to do complex procedures that would otherwise be unsafe or more difficult.
The concept was first developed over 20 years ago and has since become widely used in cardiac, vascular and thoracic surgery. Maharaj Nakorn Chiang Mai Hospital was the first hospital in Asean and among the first in Asia to install the system. “We are a medical school with a mission and vision to meet international standards. We pay special attention to service, research and learning experience for medical students. We would like to highlight the fact that we have complete medical services and we try our best to perfect the best service for our patients. That’s why we have this robotic system installed,” Dr Bannakij explained.
The Hybrid OR allows for more minimally invasive procedures. These are less harmful to patients, especially elderly patients with two diseases who cannot tolerate invasive open surgery. It also reduces infection risks, cuts surgery times and allows patients to be released from hospital earlier.
SPEEDY RECOVERY
When the nurse told Mr Chuchart about the Hybrid OR, he didn’t understand how it would benefit him. He thought his experience would be similar to his previous heart surgery — painful and unpleasant. He remembered that it took him many months to get back to normal.
An operation on an aortic aneurysm is quite a major and complicated procedure. Traditionally, it requires open surgery, which means the doctor has to cut the patient in the area where surgery is required. But that’s no longer the case.
The Hybrid OR allows doctors to see real-time images during the procedure. The system allows for more sophisticated functional and 3D imaging. This gives the surgeon more information about the patient’s anatomy and the progress of the intervention than they would get from conventional image guidance. It can drastically
reduce complication rates. For many procedures the patient would generally be sent for CT or MRI scans one or two days after surgery for a post-operative check. The images would possibly show that the patient has be operated on again. With the imaging capabilities of the Hybrid OR, this control can be done immediately after surgery, with the patient still on the table and sedated. If the images show any issues, they can be taken care of by the surgeon right there and then.
“The less we move patients from the operation table, the safer it is for them. We find it much safer and easier for many complicated procedures such as brain, spinal and heart surgery when using the Hybrid OR,” Dr Bannakij explained.
After surgery, Mr Chuchart was sent to a recovery room where he spent only a few days. Without even knowing the details of the procedure, he got back on his feet as soon as he left the surgery room.
“I didn’t need a wheelchair to push me around after the surgery. I walked right to my daughter’s car when she came to pick me up and I started working around my home as if nothing had happened. Unlike the heart surgery, I feel no pain at all after this surgery,” Mr Chuchart said.
UP AND READY
Chiang Mai University has just officially launched its first Hybrid OR. Hundreds of hospitals in Japan and China have been familiar with this technology for quite a while.
Even though it is not something new to the world, it is good news for the medical industry in Thailand that high-tech equipment is available to treat complicated conditions.
The benefits are lower complication rates, the ability to do more complex procedures, shorter operation times and shorter hospital stays. In many Thai government hospitals, the numbers of beds is not always enough to accommodate patients who need to be hospitalised. This technology can help ease that problem.
The system has no ceiling components that can interfere with the laminar airflow, which is important to minimise infection risks during
I didn’t need a wheelchair to push me around after the surgery
CHUCHART PINJAI
surgery. With its robotic arm, the system can support procedures with full 3D imaging being positioned on the head side, left side or right side of the patient.
According to Siemens Healthineers, the company that supplied the imaging system at Maharaj Nakorn Chiang Mai Hospital, the system can produce real-time images with a resolution about four times higher than before. Due to its image guidance features and 3D imaging capabilities, the system can reduce operation times significantly compared to conventional surgery
The 3D imaging where the system quickly rotates around the patient can be performed up to 15% faster when compared to previous systems, now with the shortest acquisition program taking just under five seconds.
This reduces image artefacts from patient movement and reduces the amount of contrast media required.
The system uses adaptive image algorithms which automatically optimise visibility of different structures while reducing the required X-ray dose that the patient is exposed to.
“We can now minimise major surgery to be an easy operation. The robotic arm helps us work in the surgery room more efficiently, but the most important thing is that we can improve quality of life among patients after surgery,” Dr Bannakij explained.
Dr Surin Woragidpoonpol, head of cardiovascular and thoracic surgery at the department of surgery in Chiang Mai University’s faculty of medicine, said the technology will transform surgery. From open and major surgery to keyhole surgery, the system will reduce pain and the risk of infection.
“In the traditional way, when patients get transferred from the operation room to the X-ray or MRI scan room, they may risk catching an infection along the way. But with this new technology, everything can be done in the same place,” Dr Surin said.
“The best part about it is the reduction in recovery time.
For example, patients usually take seven to 10 days to recover in hospital after major operations such as brain or heart surgery. But with the Hybrid OR, patients only require six to eight hours in the recovery room before transferring to their room and they only have to stay one to two days before they are allowed to go home. The operation time is also reduced by 50%.”
Mr Chuchart was one of the first patients to receive aortic aneurysm surgery. Traditionally, the doctor has to cut open the abdominal area, passing blood vessels and bones before getting to the spot where they want to operate. But the new system reduces the invasive process by combining it with percutaneous transluminal coronary angioplasty (PTCA) that the hospital has been using for more than 10 years.
“We make a small hole no larger than two inches in the groin area. Then we insert a camera and equipment through the blood vessel to reach the area we want to work. With the old scanner, we see images of the equipment as shadows. But with the Hybrid OR, we can see real-time images with every single detail including smaller blood vessels that the old machine was unable to show,” Dr Surin said.
Dr Kittisak Unsrisong, an expert from the department of radiology in Chiang Mai University’s faculty of medicine, said the Hybrid OR makes X-rays and surgery easier because the patient doesn’t need to be transferred to a different room.
“The most beneficial part for patients is that the machine produces less radiation due to the shorter scanning process. Head scanning is 68% faster than with the traditional machine and body scanning is 15% faster. The average time for the scanning process is four seconds. The robotic arm is also adjustable to suit the body size of patients,” Dr Kittisak said.
Dr Bannakij revealed that the Hybrid OR cost 70 million baht. The university invested 30 million baht to improve the operation room and will spend 2 million baht per year for maintenance after the third year of its operation. It is now fully equipped and ready to use as seven patients have already received free operations as part of the trial period.
“Normally we spend 80 million baht for just a CT or MRI scanner, but now we can have the complete scanner with an operation table all in the same room,” Dr Bannakij said.
“Though we haven’t yet determined operation fees with this machine, I will make sure that it is accessible to everyone.
“I can guarantee that this machine is a good investment for the benefit of patients. We are not installing this to make more money. The aim is to save more lives and improve patients’ livelihoods.”
“I can guarantee that this machine is a good investment for the benefit of patients
DR BANNAKIJ LOJANAPIWAT