Money FM89.3 Influence – Robotic Surgery & Prostate Cancer
On-Air Interview Transcript:
The Curve with Michelle Martin and Bernard Lim replay from Money FM 89.3.
Michelle Martin:It is time for influence. I’m Michelle Martin. My invited guest today is Dr Chong Kian Tai. He’s a specialist in urology from Pan Asia Surgery Private Limited. When robots get involved in surgery, there is generally less blood loss. Fewer perioperative complications and shorter hospital stays compared with open surgery, but does it cost any more than open surgery or take longer to perform, or less? Today we meet Dr Chong as we asked, how is robotics advancing the treatment of cancers? Dr Chong specializes in urology and robotic surgery. He is a founding member of the Singapore Neurological Cancer Consortium and has lead research teams in cancer research in the areas of biomolecular medicine, bioimaging, even novel Biomedical Device Studies. So, welcome. Welcome to Influence. doctor. Can you share with us a little bit of your thoughts of that, that big question that we’re asking today.How has robotics advanced the treatment of cancers in Singapore?
Dr Chong:Thank you Michelle for having me here on live radio. And robotic surgery has changed a lot over the decades. In the past, we used to use a robot in factories and they are just some machinery that help you get, um, factory manufacture stuff, but recently we have use a robot more for human. Now let me get this clear. Robot surgery doesn’t mean we stay at home and press a button and robot operate. Thank goodness. So the most important thing is, we are actually surgeons controlling the robot, so we make use of the robot to do a better surgery. So for your question about doing in robotic cancer surgery, one of the biggest advancements for urology is using it for prostate cancer treatment. And in America, prostate cancer is the number one cancer for men, uh, other than non-skin cancer in US. And in Singapore cancers, prostate cancer is the third most common cancer in Singapore. So having the robot surgery actually helps a lot because number one, we can see the anatomy of the prostate gland much better because there’s 3D, high definition TV screen and when we operate the robot, it is as if our arms and fingers are right in the patient’s body, but the patient only has a small little keyhole scar on the wound. So that’s what we’ve been doing for more than 10 years.
Michelle Martin:So this is, um, can you share with us, what exactly this robot does in terms of helping you with the keyhole surgery? Sending in that little micro tv we could imagine helping you with the incisions, how exactly does this work?
Dr Chong:So the robot, the machine that we use is called da Vinci robotics. It is a monopoly actually for this company because they are the only available surgical robotic instrument in the world, although there are more research coming out. The rest are still in research. So how do we use this da Vinci robot? Firstly, it is actually a keyhole surgery, but a keyhole surgery with the end of the instrument right in the patient’s body where we have instruments that act like a risk inside the patient’s body. So it is more precise. We can operate as if our fingers are inside the patient’s body. So, which is why we love it. Uh, it reduces blood loss, give us better precision in placing our needles and suturing.
Michelle Martin:Does it take any longer than open surgery?
Dr Chong:In well trained surgeons, it usually takes a bit, slightly longer. Number one, because we have to make sure we, what we call docking of the robot, is placed in the right position before we start. So this compared to traditional open surgery where we simply make a cut on the skin, but this time for the robot we have to place in the right position before we start. So overall it takes slightly longer than the traditional open method. But I think the ultimate aim for cancer surgery is to remove the cancer completely. Made sure the patient is safe and go home in a few days’ time back to the family.
Michel Martin:What does the robot do once it is inside the cavity area for urology and cancer?
Dr Chong:So for urology or cancer surgery, for example, prostate cancer or kidney cancer. Once it is inside, we actually control it through an external device. And as a surgeon, I’m not next to the patient, I’m not touching the patient but I’m actually at the console where I can control the robot somewhere far away, so actually if you think about it, you can actually operate from this studio on a patient in the hospital somewhere else. We just need Internet connection because we can simply go through the, uh, the electronic circuits and control the robot somewhere far away.
Michelle Martin:Is that already a reality?
Dr Chong:It is a reality. Uh, but as a patient, would you actually prefer your surgeon to be near you or somewhere in?
Michelle Martin:Well, if the surgeon that I trusted was living in the states, I wouldn’t. I mean he was far away, but within range I’d rather he did it remotely.
Dr Chong:Well that’s always possible, but I think the reality is most of us prefer to see the surgeons just before operation and make sure they are around.
Michelle Martin:Interesting that capability does exist though. Uh, what do you think patients should understand? I mean, when do you determine that, yes, you’ll use this robotic system when you see a patient with urology issues?
Dr Chong:So for cancer surgery, what I’ll determine is whether patients are suitable for the use of robot and we must think of the use of robots as a tool. For example, if you think about Michelangelo painting the Sistine Chapel, is it a paint brush that’s important or the person behind the paint brush? So, if we think of a da Vinci robot as a paintbrush, it is also the combination of skills, understanding of how to do the surgery together with a good tool that helps. So I think to recommend a robotic surgery, number one, the surgeon must be competent and comfortable with the surgery, and number two, the surgeon must know how to operate and use it properly.
Michelle Martin:And does the type of cancer matter? Where it is located? Stage?
Dr Chong:For urology, we commonly use it for prostate cancer because it’s very deep in the pelvic area, which is very hard to reach it by the open traditional method.A second thing for urology, we use it for small kidney tumor. Many of us have gone for health screening and sometimes we do see small kidney tumor in even younger patients. So when we do a robot surgery, it gives us ability to only remove the tumor from the kidney and leave the rest open. It’s like a pizza. You just cut a piece of pizza, there’s no good and then use stitch back everything else that’s normal and you can have much better precision in suturing back
Michelle Martin:And so faster healing then?
Dr Chong:Faster healing and less blood loss.
Michelle Martin:Just terrific. Are there any cons at all to using robotic surgery?
Dr Chong: Well in Singapore we are actually very lucky in the sense that most of our public hospitals have robot machine each, majority of them. And in the private sector there are two machines as well. So actually as a community in Singapore, we are blessed with the ability to pay for the machines and a lot of our patients either in private sector or in a public institution will also benefit from robot surgery.
Michelle Martin:0Okay. And what would you advise patients when it should they be given this as an option, robotic surgery, what should they be thinking about or asking?
Dr Chong:Some of the things I think we should consider is number one, who is the doctor and surgeon operating for you, what’s his or her experience and her training and also whether they are comfortable doing this using the robotic device or simply by other methods. So firstly, be comfortable. Second, understand the good and bad points about robot. The robot, the good thing is he has smaller scar, it can reduce blood loss and it may help you in better imaging to see exactly where you want to stitch, but the bad part is, it is more expensive overall because we need to pay for the cost of the robot itself.
Michelle Martin:Okay. So how much more expensive than open surgery?
Dr Chong:It’s usually is a maybe… I can speak for public institution, maybe about 5,000 to 8,000 more. But in the private sector, it depends on the surgeon.
Michelle Martin:Okay. So, um, you know, patients are battling with costs. Again, remind them of what the outcomes that they have to weigh up as well.
Dr Chong:Yes, that’s right. So cost is one factor. And secondly, you must also think into consideration that if you go back to work earlier, you don’t have to stay in hospital longer, less risk of bleeding or pain or scar. And these are the factors that every patient need to consider before deciding which way to go.
Michelle Martin:Are there any other disciplines or any other types of cancers that this robot can help with?
Dr Chong:Yes, there are many different cancer types. For example, in fact, in two days time in Singapore, we are holding the first ever Asia summit of robotic surgery in Grand Copthorne Waterfront hotel in two days time. So some of the,the talks we are going to listen to is, uh, how to use robotic surgery in lung cancer, in gyne cancers, in colorectal cancers. And these are the new advances that are coming up as well.
Michelle Martin:Yes. Yes. Tell us about the, um, the trends and the future of robotic surgery. And you know, is it still science fiction? We think nano robots that can go in and do their own repairing, that humans don’t have to be tethered with. Is that, is that still science fiction?
Dr Chong:For now, we still trust the human doctor more than depending on purely on machines and for the next couple of years, I still think that we need to be having a good, competent surgeons who can control the robot, instead of robot controlling us. I think it may be science fiction to think that nanorobots can operate every single thing in the near future. Well, maybe when we see Elon Musk launch his first space shuttle to the moon, we may think about whether it’s going to be possible to have a robotic and AI takeover.
Michelle Martin:What, what excites you about this field? I mean the nanobots made over here in Singapore, but what excites you about where this field is heading to?
Dr Chong:I think it’s exciting because number one, we can do better surgery and patients recover much faster using a robot. Uh, as for whether Nano robots or autonomous robot can actually take over the role of a surgeon, that will require much more research. And I’m excited with the new research coming up. In Europe and US, there are some, uh, FDA and CE mark approved robots. They are now in human trials where we can see some of the robotic devices can actually curve and one of the interesting one is that you can actually put it through the mouth, it goes through your, your intestine and actually you can actually try to operate with a small instrument inside the guts.
Michelle Martin:Inside the guts
Dr Chong:And there are also small instruments that can go into the airway itself, go right into the bronchus, into the airway. So you must have a flexible tube and you must be able to do some surgery using those instruments and those are under trial at the moment.
Michelle Martin:Wow,and and all these instruments are powered, so they’re still sort of tethered to an electrical source and they ‘re not independently powered I can imagine the size and you know the powering, within the next frontier.
Dr Chong:So the future for robotic surgery is bright and more and more people are trying to see whether we can make use of it to help us.
Michelle Martin:So exciting. Okay. Before we let you go, you must tell us about how, how common is prostate cancer and what are the symptoms that people should look out for here in Singapore?
Dr Chong:So for prostate cancer is the third most common cancer in Singapore men currently. Unfortunately, most of the patients with prostate cancer have no symptoms, and the only way for them to test is a blood test called a prostate specific antigen blood test. But when this blood test is high, it doesn’t mean someone has cancer, it just means that you must check with your doctor. What could this mean? It could be a large prostate from aging, it could be a prostate infection. It can also be cancer. So the key thing is a blood test will be able to tell and help you decide whether to proceed to diagnose prostate cancer. There are also some patients who have prostate cancer that have a urine problem, like waking up at night to go to the bathroom or they go to the toilet too often or blood in the urine. So these are some things that some patients may have.
Michelle Martin:Just terrific. And this robotic helper, so to speak, our robotic surgery. Does it help at all, get rid of the cancer as early as it is found?
Dr Chong:The use of the robot is to surgically remove the prostate. It doesn’t help to diagnose earlier.
Michelle Martin:Can it go in and, and, and remove the cancer if it is still an early at an early stage
Dr Chong:Yes,the cancer can be removed completely. And the advantage for surgery is that you can remove the, uh,the cancer inside the prostate gland out completely and it’s not in the body anymore.
Michelle Martin:Really fascinating. Thank you so much for coming by.
Dr Chong:Thank you very much for having me.
Michelle Martin:On Influence.Dr.Chong Kian Tai. He’s a specialist in urology at Pan Asia Surgery telling us his thoughts on how robotics is advancing the treatment of cancers.
If you would like to speak with Dr.Chong Kian Tai to better understand
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