Surgery isn’t just a scary thought; it can sideline you from life and work for weeks, maybe even months on end. But surgical technologies have vastly improved in recent years, that it’s now possible to bounce back from a major operation in less time and with minimal pain—all without even going under the knife.
The tool that can make this happen? Da Vinci Xi, a fourth-generation, computer-assisted robotic surgery system offered at top hospital of the Philippines Makati Medical Center. Acquired by MakatMed in May 2024, the da Vinci Xi has been used in various surgical procedures, particularly in the fields of obstetrics and gynecology, urology, hepatobiliary surgery and liver transplantation, colorectal surgery, and otorhinolaryngology (head, throat, and neck). Board-certified, robotics-trained Filipino surgeons from these specializations explained the versatility of the da Vinci Xi as well as the advantages of robotic surgery to both patients and doctors in an exclusive media session.
“This technology will usher in a new era of precision,” said Saturnino P. Javier, MD, the Medical Director and Interim Co-President and CEO at MakatiMed. “Precision is a key issue that we are aiming for with this technology. Second is the less invasive nature of the procedure.”
During the tour of the surgical suites, Allan Cabayan, RN, a product specialist for da Vinci Xi briefly demonstrated what the robot’s four arms can do and how this technology reduces trauma on the body of the patient.
The tour also covered how the different components of the da Vinci Xi work and where the surgeon positions himself during the procedure.
Before the sit-down discussion, guests were suited up in head-to-toe personal protective equipment and shuttled into an operating room where they were introduced to the da Vinci Xi. The massive, four-armed robot was named after Leonardo da Vinci, 15th century Renaissance Man and artist behind the sketch of the Vitruvian Man, a symbol of the ideally proportioned human form.
Contrary to belief, the robot does not operate on its own. Rather, its arms are controlled by the surgeon through master controls on a surgical console. Besides affording them with a clearer and magnified 3D version of a patient’s internal organs, the da Vinci Xi moves more efficiently and has greater range of motion than the human hand. This results in more precise cuts and sutures, less bleeding and pain, and quicker recovery times.
Jaime SD Songco, MD, Urologic Oncologist and Chairman of MakatiMed’s Department of Surgery, was the first to use the da Vinci Xi for prostate surgery. “The da Vinci has revolutionized prostatectomy, especially for cancers. It’s the gold standard worldwide,” he shared.
Urologic Oncologist Dr. Jaime SD Songco, the Chairman of the Department of Surgery, presented an overview of the da Vinci Xi technology and its role in urologic surgery including procedures involving the prostate and the kidney.
“If the prostate is like a castañas [in size], in robotic surgery, it’s like a chico. This means you can visualize its structure very well. It’s also three-dimensional, so you can avoid more damage to nearby organs. There’s also better nerve sparing, improved continence and erectile function, and less blood loss, all of which make for a shorter hospital stay.”
Jennifer Marie M. Jose, MD, Obstetrician-Gynecologist and Section Chief of Urogynecology and Pelvic Reconstructive Surgery, has performed hundreds of robotic surgeries with da Vinci Xi—from hysterectomies and myomectomies to endometriosis resection and incontinence procedures. In such surgeries, the da Vinci Xi has helped minimize bleeding while providing her with adequate vision, dexterity, precision, and control. Robot-assisted surgeries only create small incisions that can also help reduce the chance of post-operation complications, which are a common concern among women who often juggle multiple responsibilities.
Dr. Jennifer Marie M. Jose, the Section Chief of Urogynecology & Pelvic Reconstructive Surgery, shared the impact of robot-assisted surgery on women’s health.
“In gynecology, we have the perimenopausal, the menopausal, and the reproductive age groups. All of these women benefit from this kind of procedure,” explained Asian Society of Gynecologic Robotic Surgery board member Dr. Jose, who is also an international proctor of the da Vinci surgical system in Asian countries and has proctored surgeons several times in Asia.
Before the da Vinci Xi, tumors in the mouth were reached through big incisions made on the patients’ neck, thus affecting how they swallowed and exposing them to possible infections.
“Now we can offer our patients transoral robotic surgery, by going through natural openings in the head and neck to do surgeries and resections of tumors in the upper airway, particularly the throat,” said Arsenio A. Cabungcal, MD, Consultant at the Department of Otorhinolaryngology, Head and Neck Surgery, and Section Chief of the Head and Neck Surgery. “Patients are able to eat and swallow better after the surgery because we’re more precise with the dissections. And that results in less pain and faster recovery time.”
Dr. Arsenio A. Cabungcal, a Consultant at the Department of Otolaryngology-Head and Neck Surgery and the Section Chief of Head and Neck Oncology, detailed how the da Vinci Xi technology helps surgeons access and remove tumors in the back of the throat or mouth.
Surgeries for the liver, gallbladder, bile ducts, pancreas, duodenum, and spleen are tricky because these organs are not only found in the chest area, they are also under the rib cage, making it necessary to pry a patient open. While laparoscopic surgery has done away with the need to cut a patient up, the minimally invasive approach that inserts thin rod-like instruments with a light source and camera into tiny incisions made on the patient’s body still has its limitations.
“If I perform a laparoscopic liver resection, a patient will have to stay in the hospital for 3-7 days. If I perform a robotic liver resection, a patient stays for only 1-5 days. In 1-2 weeks’ time, he or she is already traveling,” declared Catherine SC. Teh, MD who specializes in hepatopancreatobiliary (HPB) surgery and is the first female and second Filipino surgeon conferred with the Honorary Fellow of the American College of Surgeons.
Dr. Catherine S.C. Teh, the Section Chief of Hepatobiliary Surgery & Liver Transplantation, discussed the applications of the da Vinci Xi robotic system in complex surgeries that involve the liver, bile ducts, and gallbladder
Da Vinci Xi’s powerful zoom-in feature, dexterous arms, and stable high-definition camera benefit this surgeon too. Teh, who has performed over 1,000 liver resections in her career (600 of them open, 400 laparoscopic), can now do back-to-back liver resections using robotic surgery. “Robotic surgery makes the impossible look possible, and the difficult look beautiful,” shared the Section Chief of Hepatobiliary Surgery and Liver Transplantation.
Yet another complicated surgery to perform is rectal surgery to address colorectal cancer, the third most common cancer in the world and a cancer that has been diagnosed of late among individuals in their 20s and 30s. Located deep in the pelvis and surrounded by bone, nerves, vessels, and the genital and urinary organs, it can be approached laparoscopically, with the use of long instruments.
“Laparoscopy is like operating with chopsticks, but with robotic surgery, it’s like your hand is inside the patient,” shared Mark Augustine S. Onglao, MD, Consultant at the Department of Surgery Section of Colorectal Surgery, and the Skills and Technical Coordinator of the Training Committee of the Department of Surgery. “In robotic surgery, you become a four-armed surgeon, with all four arms of the robot under your direct control. Why are we so hell-bent on precision and dexterity? Because we believe, especially for cancer, better surgery leads to better outcomes.”
Dr. Mark Augustine S. Onglao, a Consultant at the Department of Surgery, Section of Colorectal Surgery and the Skills and Technical Coordinator of the Training Committee of the Department of Surgery, elaborated on the advantages of using robot-assisted surgery in colorectal procedures.
MakatiMed, which performs multiple robotic surgeries a month, is set to do more, offering training programs to its surgeons. Some are currently training to operate on the heart and other organs in the thorax. After all, the enhanced precision, visibility, dexterity, and ergonomic design of the da Vinci Xi console can help prolong the careers of surgeons by reducing natural hand tremors and physical strain, especially during long, complex procedures.
While traditional and laparoscopic surgeries will continue to have a place in the Philippines, MakatiMed hopes robotic surgery offers patients another option especially as many tend to delay consults and treatments due to fear of invasive procedures, prolonged recovery times, and potential complications.
“We will always have patients who need open surgeries and minimally invasive surgeries,” said Dr. Songco. “The da Vinci Xi platform is designed for open surgeons to navigate towards the robotic pathway. As my colleagues have mentioned, you have to be a good open surgeon before becoming a good robotic surgeon.”
For more information, please contact MakatiMed On-Call at +632.88888 999, email [email protected], or visit www.makatimed.net.ph. Follow @IamMakatiMed on Facebook and Twitter.
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