Newsletter No. 461

461 • 19.8.2015 3 u 達芬奇機械人手術系統 da Vinci® S Surgical System v 矯形外科及創傷學系梁國穗教授示範操作骨科手術機械人，至今已成功應用於十多宗 骨科手術，包括微創內固定手術 Prof. Leung Kwok-sui of the Department of Orthopaedics and Traumatology demonstrates the Hybrid Orthopaedic Robot which has been successfully applied in more than 10 orthopaedic surgeries, including minimally invasive internal fixation u x v ‘Treating early bowel cancer used to involve removing the entire organ. In endoscopic surgery, doctors remove a tumour and infected tissues nearby through an endoscope which enters through the mouth. The organ remains intact and no incision is made. Patients can eat the day after the operation.’ But Professor Chiu pointed out that no break in the skin does not mean no wound at all. Patients go through a surgery nonetheless, be it minimally invasive, non- invasive, or conventional. It’s only how it’s done that is different. With its multiple benefits and satisfactory outcomes, MIS is becoming increasingly common in the past 20 years. But the technique still has its limitations. ‘Most operations today can be carried out in the form of MIS, but it all boils down to the patient’s condition. If cancer cells have spread to the lymph glands or other parts of the body, using an endoscope is not enough to perform an accurate evaluation of the operative field. In this case, surgeons have to resort to standard open treatment.’ Equipping Surgeons with the New Skill The advent of MIS brings new opportunities as well as challenges for surgeons. Professor Chiu said that by traditional apprenticeship training, surgeons were taught to operate directly with their eyes and hands. ‘See one, do one and teach one.’ Surgeons can directly put their hands into the patients’ bodies through big incisions. In emergency situations, they can immediately exercise manual skills to react and control, e.g., to stop bleeding by gently pressing the bleeding point. To perform MIS is to look at a 2D screen to perform a 3D surgery. ‘It feels a bit like you are operating with your hands tied. But the advantage is that the laparoscope can take you to a close inspection of the affected area.’ In view of the different skills required in MIS, the University established the MISSC to meet the needs of training to uphold the surgical standards for current and future surgeons. Professor Chiu said that precision is crucial in performing MIS. Unexpected bleeding during MIS operation may be difficult to control. Therefore, pre-surgical training is of vital importance. ‘Surgeons go to classes to observe how operations are done, and to practise using computer simulation. They also have to practise basic surgical steps on animal models. When they are fully acquainted with the procedures and techniques, they are allowed to assist the chief surgeon to perform simple procedures in a surgery. Eventually they’d take charge of the whole surgery under the surveillance of their trainers. Both teaching and learning require time investment.’ Achievements Remarkable Twenty-five years have passed since the first MIS was performed in Hong Kong. The Department of Surgery has reached one milestone after another in research, application, promotion and training. The MIS technique has been applied to gallstone removal, bowel cancer, gastric cancer, adrenal gland, liver, lung, and kidney. In 2005 the department introduced the first da Vinci® S Surgical System in Hong Kong, followed by an updated version in 2008. The surgeon at his/her control console now sees a superior 3D high-definition image of the operating field. Since the first performance of non-invasive endoscopic surgery in 2004 and submucosal endoscopic tunnelling surgery in 2010, last year, the Faculty of Medicine completed Asia’s first Gastric Pacemaker implant surgery for a patient suffering from gastroparesis. ‘Over the last 10 years, MISSC has trained over 15,000 health care professionals. About 70% are from Hong Kong, and the remaining 30% from the mainland, South Korea, Japan, Taiwan, Singapore, Australia, etc. The most iconic training programme is on robot-assisted surgical operation. In Asia, only Hong Kong, South Korea, and Japan offer such courses. More than 950 surgeons and 450 nurses have completed their robotic training so far. In 2008, MISSC became Asia’s first accredited robotic surgery training centre,’ said Professor Chiu. Looking Ahead ‘But we are not engineers,’ Professor Chiu said, ‘We don’t have any clue if any engineering innovation can be applied to medical treatment. That is why the University established the Chow Yuk Ho Technology Centre for Innovative Medicine earlier this year. I took up the role of its director. The centre is to bring engineering and medical research together for the benefit of the patients. It focuses on three research areas in biomedical engineering— robotics, imaging and biosensing, including nano- robotics, innovative neuro-imaging and non-invasive medical monitoring. We aim to transfer innovative technologies to the area of clinical equipment and practice, in order to enable a more effective and up-to- date treatment for patients in need.’ w 趙偉仁教授示範以內鏡手術機械人進行內鏡黏膜下剝離術 Prof. Philip Chiu demonstrates the use of the endoscopic surgical robot to perform ESD x 鷹爪縫合器可通過內視鏡在人體體內縫合潰瘍以控制出血 Eagle Claw is capable of suturing inside the gastrointestinal lumen through the endoscope to control ulcer bleeding w