Chinese doctors visit Korea for advanced robotic surgery

By Lee Kyung-min

Mohammed Al Duhileb started training at the Catholic University of Korea Seoul St. Mary’s Hospital in September 2016 to study with Professor Chae Byoung-joo of the Department of breast and endocrine surgery. The graduate of King Faisal University said he is among many Saudi Arabian doctors who are increasingly keen on learning about the advanced medical technologies of Korea.

“I came here to learn about the medical advances of minimally invasive surgery. I heard so much about the Korean medical system from many of my senior colleagues who had visited Seoul before I did, which helped me decide to apply for the training here. There is nothing to miss. The skills of the surgeons, especially in the field of minimally invasive and robotic surgery, is far more advanced than that of other countries. I was also impressed how the doctors here care about the emotional and psychological well-being of their patients.”

Laparoscopic surgery, or minimally invasive surgery, involves a video camera-tipped cable and several other thin instruments going inside the body through small incisions to allow viewing of a section of the body that requires surgery. Unlike the old way where doctors have to cut through the body including large abdominal muscles to reach vital organs, the modern way means much less trauma to the body of a patient, faster recovery and fewer days of hospitalization.

While all technologies are worth learning, he said he found it helpful to experience robotic thyroid surgery. “I would recommend doctors in my country and other countries come to Korea for training.”

Not many people have medical checkups in Saudi Arabia. Those who visit the hospital are mostly terminal patients for whom laparotomy is needed, not laparoscopic surgery. This leads to many Saudi surgeons seeking training in other countries with advanced medical technology such as Korea where most patients have operations in the early stages as a result of regular checkups, which translates to surgeons here having ample experience.

Dr. Rafat Bahjat Zahid, the deputy director of the Multi-Organ Transplant Center at the Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, underwent an 11-month training program at Asan Medical Center in southern Seoul to learn laparoscopic surgery from urologist Hong Bum-sik.

The urology specialist at the PSMMC, a leading hospital in the Middle East specializing in organ transplant visited by around 40,000 outpatients, came to Korea to improve his surgical skills and better integrate his medical knowledge into treating patients. After he returned home, he performed 50 successful laparoscopic hand-assisted donor nephrectomy operations and established a multi-organ transplant center at which he is a deputy director. PSMMC has over 1,700 beds visited by around 118,000 emergency patients a year.

The two surgeons are among many Saudi doctors who have completed or are undergoing the medical training program between Korea and Saudi Arabia started in 2014. It was organized by the Korea Health Industry Development Institute (KHIDI), a health ministry-supervised organization. The training program was expanded in May 2014, less than a year after the first one was launched in September 2013. The Saudi government pays $3,000 per month per doctor to train them here. Korea is the fourth country to have the government-level bilateral program with Saudi Arabia after the U.S., Canada and France.

Five hospitals that provide training include Seoul National University Hospital, Yonsei University Health System, Catholic University of Korea Seoul St. Mary’s Hospital, Samsung Medical Center and Asan Medical Center. Mongolia and Russia began sending doctors to Korea, in 2012 and 2013, respectively, so they could learn advanced medical technology at a state-organized program.

Korea’s excellence in robotic prostatectomy

Dr. Rha Koon-ho, a professor of urology and the director of the Robotic and Minimally Invasive Surgery Center at Yonsei University Health System, played a key role in adopting robot-assisted surgery in Korea after he first performed one in 2002 at Johns Hopkins Hospital in the U.S.

Rha, a premier robotic surgeon specializing in treating prostate, kidney, bladder and urethral cancer, has performed over 2,500 robotic surgeries since 2005, when the hospital adopted the Da Vinci Surgical System, a robot-assisted surgery system made by a U.S. company Intuitive Surgical. The system helps a doctor perform an endoscopy using three-dimensional imagery to remove the gallbladder or prostate gland by using the robot’s four arms that go inside a patient’s body and locate where surgery is required. With the help of a camera-tipped instrument, the three surgical equipment-tipped instrument arms incise the point, ligate, secure and suture the wound, all of which can be observed by a doctor on a monitor. The number of Da Vinci-assisted operations at Yonsei University Health System, the first Korean hospital to use the minimally invasive approach to facilitate complex surgery, is set to surpass 20,000 next month.

“The sheer number of operations is also noteworthy but I put more emphasis on the experience and data accumulated over the past decade,” Rha said. “Apart from the precision- and dexterity-improving qualities, the recorded footage of the operation enables doctors to study and learn to better execute masterful surgery.”

His experience and insight were also instrumental in developing Revo-i, the first domestically developed robot-assisted surgery system manufactured by Meere Company in Korea. Revo-I is the second such system after Da Vinci approved for surgical use globally. The system, which won approval from the Ministry of Food and Drug Safety last year, following successful clinical trials based on research and development for over a decade. Over 20 billion won ($19 million) in state grants has been invested after the Ministry of Trade, Industry and Energy designated the project a state initiative to foster development of surgical robots in 2007.

“We have been making various attempts to implement different surgical approaches using the robot-based system since about four years ago. The prime technology and experiences of seasoned surgeons are great components to achieving innovative surgical technique development,” he added.

Many foreign doctors seek training programs to learn under Rha including doctors from the U.S., Japan, China, Taiwan, Saudi Arabia, Kuwait, Malaysia, the Philippines. “Operating many training programs in Korea for foreign doctors is among many indicators how the country has improved its standing on the global medical stage,” Rha said.

Rha was among many high-profile figures who attended the Global Future Medicine Symposium 2017 in Beijing, China, last November, alongside Hanyang University department of medicine professor Tae Kyung and Korean Society of Medical Robotics Chairman and Hanyang University electronic systems engineering professor Yi Byung-Ju.

Over 30 robotic surgeons and 120 medical students in China attended the conference including Zhou Liqun, a premier robotic surgeon, and Beijing Medical Doctor Association chairman Guo Jiyong.

According to KHIDI data, 60,257 surgeries were performed using 66 Da Vinci Surgical Systems in China as of last year, since the country first adopted the U.S. system in 2006. Of the total, almost half, or 45 percent, accounted for treating urinary diseases, followed by obstetrician and gynecological diseases (12 percent), thoracic surgery (12 percent), colorectal disease (11 percent) and liver surgery (10 percent).

Korea’s excellence in robotic thyroid surgery

Kim Hoon-yub, an endocrine surgeon at Korea University Anam Hospital and an associate professor of surgery at Korea University, developed a procedure for transoral thyroid surgery, noted by the Natural Orifice Transluminal Endoscopic Surgery (NOTES) for the thyroid gland. The surgical method uses a robotic arm below the chin and inside the mouth, so the operative scars are invisible. His work was published in Surgical Endoscopy, a leading peer-reviewed medical journal of endoscopy.

Jonathon Russell, director of endoscopic and robotic thyroid and parathyroid surgery at Johns Hopkins, came to learn from Kim in July 2016. Three months later, Eren Berber, an endocrine surgeon from the Cleveland Clinic in Ohio, also visited Kim in October to learn. He has visited many top global hospitals to demonstrate the procedure including Johns Hopkins, the Cleveland Clinic and the University of Insubria in Italy.

Korea spent 19.6 billion won ($17.3 million) last year to import surgical robots, up 34 percent from a year earlier.

The surgical robot industry is growing worldwide, reporting a 12.1 percent annual increase. The worldwide market is expected to be worth 9.6 trillion won by 2021. According to “Markets and Markets,” a market tracker, the global market for medical robots is expected to grow by 22.2 percent on-year on average, reaching $11.4 billion by 2020, up from $ 4.2 billion in 2015. The U.S. Economic Cycle Research Institute picked surgical robots as one of the 10 innovations in 2016.

Medical Korea to boost academic exchanges with China

Experts in robotic surgery from both Korea and China will speak at special sessions at the “Korea-China Medical Robot Symposium” at 9:30 a.m. at the Intercontinental Seoul COEX, southern Seoul, May 9. The sessions which will be participated in by the Korean Society of Medical Robotics are part of Medical Korea 2018, an annual event organized by the health ministry and the KHIDI. The three day event will end on May 11. More information can be found at www.medical-korea.org