At work: Team uses a robotic surgical machine to perform a delicate procedure at Bunda Hospital in Jakarta. (Bunda Hospital)

Robotic surgery is an amazing technological development in medicine '€” and one hospital in Jakarta is making it possible for patients and doctors to take advantage of breakthrough.

The benefits are legion: Human-guided robot surgeons can reach areas inside the body that are hard to be seen by the eyes. Recovery phases are shorter, too, and there are no significant scars left on the body after
a procedure.

Ivan R. Sini, the physician who operates the robotically assisted surgical system at Bunda Hospital Jakarta, said the system was introduced in Indonesia in early 2012. So far, it has had a satisfying success rate.

'€œA surgeon often finds trouble during major surgery to find tissue that is located in difficult areas due to the limited sight of the surgeon,'€ Ivan said in his opening speech to mark the first 50 cases of robotic surgery performed at the hospital. '€œSurgery that uses microscopes has proven to be an alternative, because it can minimize the scars and patients can recover faster.'€

Ivan said that since the technology was introduced, the hospital'€™s robotic surgery team, called ARMIS (Advanced Robotic and Minimally Invasive Surgery), had successfully performed robotic surgery for 50 patients, comprising 47 gynecology surgeries, two prostate surgeries and one urology and gastrointestinal surgery.

The machine: The robot surgical machine used at Bunda Hospital in Jakarta. The hospital'€™s Advanced Robotic and Minimally Invasive Surgery Team is marking successful robotic surgery for 50 patients. (JP/Novia D. Rulistia)According to Ivan, robotic surgery in Indonesia still focuses on four areas: benign gynecological procedures, gynecological cancer, urology and digestive cases.

Currently, robotic surgery is only available at Bunda Hospital Jakarta in Indonesia.

The use of robots to perform surgery started in Vancouver, Canada, in 1983. The first robot was named Arthrobot and was developed and used by a team led by James McEwen and Geof Auchinlek in collaboration with orthopedic surgeon Brian Day. Since then, many medical robots have been developed to help doctors perform surgery.

The medical robot in Bunda Hospital is produced by Intuitive Surgical Inc. and comprises three components.

The first component is a vision cart that holds a 26-inch high-definition monitor, 3D camera, light source, central control unit and data processing center.

The second is the patient robotic cart. It has three arms: one camera arm and two instrument arms. The instrument arms have a '€œjoint'€ system called the endowrist instrument which allows 520 degrees of rotation (that is a full circle and then some '€” important when performing some procedures).

The camera arm has high-definition 3D video camera that can produce clear picture of the incision area when all arms are put into the body.

The third component is the doctor'€™s console, from which the surgeon controls the instruments through a master controller. From the screen, the doctor can view the incision area clearly in 3D and can magnify it digitally.

Arie Polim, the gynecology laparoscopy coordinator and member of ARMIS, said that robotic surgery could be a bridge between open surgery and laparoscopy, thanks to its flexibility.

He said that open surgery was not ergonomic sides and had a long recovery phase, despite its simplicity. While laparoscopy allows for faster recovery phase and allows doctor to use cameras to do surgeries, it was not ergonomic and offered only a restricted degree of motion.

Up close and personal: A monitor in the robot surgical machine'€™s command console depicts how small tools can hold minute blood vessels inside a human body. (JP/Novia D. Rulistia)'€œRobotic surgery can cover the drawbacks in open surgery and traditional laparoscopy. For example, during major surgery that takes hours, we get tired as we have to stand and we may experience hand tremors,'€Arie said. '€œBut in robotic surgery, we can just sit down, and even when our hands are shaking, the instruments won'€™t shake.'€

Sita Arumi, the gynecology robotic surgery coordinator, said patients recovered fast since robotic surgery only required incisions of 2 to 3 centimeters.

'€œIn addition, patient can recover quickly because during the surgery, the bleeding was only less than 100 ccs, and that'€™s very little. That'€™s why it'€™s easy for them to recover,'€ she said.

Despite the benefits, patients still need to pay a great amount, ranging from Rp 80 million (US$8,080) to Rp 100 million.

Ivan said that the price was actually cheaper than those offered by hospitals in Singapore, which charged Rp 250 million for such procedures, or those in Malaysia, which charged around Rp 150 million.

Wachyu Hadisaputra, the president of Indonesian Gynecology Endoscopy Society (IGES), said that the arrival of robotic surgery in Indonesia would improve the country'€™s healthcare.

He said that IGES would recommend that its members learn how to perform robotic surgery.

A patient of robotic surgery, Cut Yunita Ichsani, said that she underwent a robotic procedure to remove fibroid cysts in February last year. Cut said it only took two days for her to recover and that the post-surgery scars were just like three dots in her stomach.

The surgery also discovered a new problem that surgeons were able to solve.

'€œWhen I was on the operation table, the doctor also found a tumor. It had been undetected before,'€ she said.