Robotic computer system develops high-skill 'technosurgeons'.

Just 15 months after four highly sophisti cated robot­ assisted da Vinci Surgical Systems were introduced to South Africa (SA), nine local urologists are now 'flying' the ZAR23 mil­ lion devices 'solo' , while another ten are being mentored on the revolutionary robot­ ic­assisted laparoscopic tool. The surgical robotic system (four surgeon-controlled operating 'arms') was introduced via Earth Medical to four private hospitals in Cape Town, Johannesburg and Pretoria and gives highly skilled, appropriately trained specialists greater vision, precision and control during procedures, going beyond the flexibility and rotational capabilities of the human hand. It has also highlighted innate hospital/doctor and funder tensions in providing expensive but effective high-tech medical equipment while maintaining viable patient funding. However, and perhaps most importantly, the da Vinci system has exposed an 'elephant in the room' – the internationally aberrant overuse by SA specialists of brachy therapy as a treatment modality for prostate cancer (73% above the global norm). Funded as a prescribed minimum benefit by medical aids (as is open prostatic surgery and traditional keyhole surgery), brachytherapy (the relatively quick and highly strategic placement of a radioactive 'pellet' at the prostate cancer site) allows urologists to conduct twice as many procedures a day as is possible with open or laparoscopic surgery. Top academic compares treatments – and backs the device Top academic and urologist Prof. André van der Merwe of Stellenbosch University conducted an in-depth comparative litera ture study of the available treatment modalities for prostatic cancer in SA. He concluded that brachytherapy 'should be reduced to international proportions (i.e. to 7% from the SA usage figure of 80%)' , with robotic laparoscopic surgery a 'valuable tool' in helping achieve this. In his paper, he neutrally comments that 'should the caring physician benefit from one of the many options, then he might be biased in the manner he counsels the newly diagnosed patient' , adding that a powerful differential exists between the urologist and the patient in consultations after a diagnosis of prostate cancer is made. Izindaba interviews with well-placed expert sources gleaned anecdotal evidence that some urologists often fail to discuss the pros and cons of various therapeutic options with their patients (most have very similar eventual outcomes), pushing brachytherapy and often not mentioning the sometimes appropriate strategy of 'watchful waiting' and active surveillance. Dr Jonathan Broomberg, CEO of SA' s largest open medical aid, Discovery Health, said it was 'critical' that …