Aga Khan University Hospital has taken a major step in expanding minimally invasive surgery in Kenya after successfully performing a robotic-assisted gallbladder removal, a development doctors say could pave the way for more complex operations to be performed through smaller incisions.
The procedure, known as a cholecystectomy, is commonly performed to remove a diseased or problematic gallbladder. While the operation itself is not new, the use of robotic technology could change how increasingly complex surgeries are performed.
Dr Abdulkarim Abdallah General Surgeon and Chair, Department of Surgery Aga Khan University Hospital said that the technology allows them to have a 3D view over a 2D view that one gets in laparoscopy.
“The advantage of having instruments that have an increased range of motion which makes the maneuverability within the abdomen much better than the normal laparoscopy,” said Dr Abdulkarim – who was part of the team involved in the first robot assisted removal of the gall bladder for a patient at the Aga Khan University Hospital.
“The patient had stones in the gall bladder which is a condition that causes pain in the abdomen, and because of that they require the removal of the gall bladder together with the stones, which have removed in many different ways. In this particular instance, we have done the process with robot assistant minimal invasive surgery,” said Dr Abdulkarim.
According to Dr. Brian Misoi, a general surgeon and liver and pancreas surgeon, the technology could allow surgeons to undertake procedures that have traditionally required open surgery while reducing the size of the incisions made on patients.
“So, most of the aggressive surgeries that we do, we've been performing them open because they're difficult to perform laparoscopically,” says Dr. Misoi, the Hepatopancreatobiliary Surgeon at the Aga Khan University Hospital.
Conventional laparoscopic surgery uses long, straight instruments inserted through small incisions. Although the technique is already less invasive than open surgery, the limited movement of the instruments can make some complex procedures difficult.
Robotic systems use articulated instruments that can move in ways that more closely mimic the surgeon’s hand.
Dr Abdulkarim notes that the robot assisted technology has a wide range of advantages.
“First, it allows the surgeon to sit comfortably while undertaking the surgery, which improves back issues for the surgeon who may need to sit down for long hours. Secondly, the robot is able to look around curves, so the surgeon can go deeper into cavities and have a look at structures that would otherwise not be accessible in open surgery or accessible with difficulty in laparoscopy.
“But now with the robot, which has articulating arms that mimic almost your hand movements, then we are able to do more aggressive surgery through smaller cuts,” Dr. Misoi explains.
This could be particularly useful for operations involving difficult-to-reach areas of the body.
Dr. Misoi says procedures involving the pelvis, chest and upper abdomen could benefit as the hospital expands its robotic surgery programme. These include some urological procedures, gastrectomies, hiatal hernia repairs and complex pancreatic surgery.
The technology could also significantly change the recovery experience for patients.
Unlike open surgery, which requires a larger incision, minimally invasive procedures involve smaller cuts through which surgical instruments are inserted.
“There’s a significant difference in recovery between minimally invasive surgery and open surgery because the cuts are much smaller,” Dr. Misoi says.
He says smaller incisions generally mean better pain control, earlier mobilisation and shorter hospital stays.
For example, a patient undergoing an open gallbladder removal could spend four to five days in hospital. With minimally invasive surgery, the patient may be discharged as early as the following morning.
“Whereas in this kind of minimally invasive surgery, the patient will be discharged the following morning, 24 hours,” he says.
However, robotic surgery does not eliminate the risks associated with an operation.
Dr. Misoi says the procedure remains surgery, meaning patients are still exposed to potential complications. In some cases, surgeons may also need to abandon the minimally invasive approach and convert to open surgery if complications such as uncontrolled bleeding arise.
“Because it's the same surgery that you do in open surgery, the same risks confer in robotic surgery,” he says.
For patients undergoing gallbladder removal, the absence of the organ also does not fundamentally disrupt digestion.
The gallbladder stores bile produced by the liver. Once removed, the liver continues producing bile, which flows directly into the intestine.
Patients may initially experience difficulties, particularly when eating fatty foods, but Dr. Misoi says this usually improves within about one and a half to two weeks.
“After that, you should be able to scale back to your normal diet. So, most patients live a normal life after their gallbladder has been taken out,” he says.
For Aga Khan University Hospital, the immediate procedure could therefore represent a much broader shift in the hospital's surgical capabilities.
Dr. Misoi says robotic technology could make complex surgery more tolerable by reducing surgical trauma while allowing surgeons to work in areas where conventional laparoscopic instruments have limitations.
“This means that we can now begin to do more aggressive surgery with less invasion in terms of the cuts that we do,” he says.
He adds that reducing the size of surgical incisions could also lower some of the long-term problems associated with larger cuts, including persistent pain and abdominal wall hernias.
The future of robotic surgery, however, will depend on how far the technology and the skills of surgeons develop.
Advances in articulated instruments, surgical techniques and imaging technologies such as indocyanine green (ICG) could give surgeons greater precision and visibility during complex procedures.
Dr. Misoi says this could eventually allow more operations that are currently performed through large incisions to be carried out using minimally invasive techniques.
“As we continue to scale up the procedures that we can offer on the robot, and the robot advances in terms of the articulation and the instruments and the different techniques you can use on the camera, then that allows us to perform more aggressive surgeries with smaller cuts,” he says.
For patients, the promise is straightforward: less surgical trauma and potentially faster recovery.
For surgeons, the technology could provide greater flexibility and precision.
And for Kenya and the wider region, its significance could ultimately lie in expanding access to advanced surgical techniques without requiring patients to undergo the larger incisions associated with conventional open surgery.
