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Robot surgery begins in SA

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Chantelle Gouws has became the first person in South Africa to undergo a partial nephrectomy using da Vinci robotic-assisted technology. The organ-preserving excision of a cancerous tumour from her kidney was done at Netcare’s Waterfall City Hospital in Midrand.

The 29-year-old from Springs also became the first woman to undergo a procedure using the da Vinci robotic surgical system in South Africa.

“I was nervous before I knew what was wrong with me. Now I’m not nervous at all. I have a really, really good doctor and was quite surprised when I found out my procedure would be a double first,” Gouws said, from her hospital bed shortly before her operation.

“It is amazing to know that medical technology has progressed so much. I’m now very calm and comfortable about the procedure because I know Dr Conradie will remove all of the tumour accurately,” added Gouws.

Her surgeon, urologist Dr Marius Conradie, said doing a partial nephrectomy was an extremely intricate and exacting procedure.

“There’s a number of blood vessels involved in the reconstruction of the urinary tract. Any mistake and the patient could bleed to death on the operating table,” he said.

Gouws’ tumour was diagnosed after an ovarian cyst burst about two months ago while she was at work. The cyst had gone undetected, as she had not been seeing her gynaecologist regularly. During an ultrasound examination by her gynaecologist the golf ball-sized mass in her right kidney was incidentally discovered.

Up until now urologists have been using the highly sophisticated technology, which was installed at Netcare Waterfall City and Netcare Christiaan Barnard Memorial Hospital to operate on men, mainly for the surgical removal of the prostate gland.

The system consists of a console where the surgeon sits, peering into a screen, using foot pedals and hand controls to remotely operate the surgical instruments attached to four robotic arms on a second console at the operating table.

Controlled by the surgeon at the console, the robotic arms do the cutting, clamping and cauterising with far greater flexibility and precision than is possible with human hands.

Unlike traditional surgery, da Vinci robotic-assisted procedures are minimally invasive. The instruments are inserted through small incisions.

“With this technology we can view the magnified organs, blood vessels and surrounding tissue in 3D, so that the surgery can be performed much more accurate,” said Dr Conradie.

During the surgery Dr Conradie used an ultrasound probe to determine the extent of the tumour, to make sure they remove all of it. It was an ‘angry red thing’, about 4cm long, on top of the kidney, which he successfully excised.

“It operation went extremely well,” Dr Conradie said afterwards.

Gouws is expected to be in high care for a day and will thereafter be transferred to a general ward for two days, after which she will be discharged from hospital. She will be back at work in about one week to ten days.

Gouws does not have children, only a “loving boyfriend”. She said Dr Conradie had told her having children should not be a problem, but that they should first do the procedure and then see what the outlook was.

Dr Conradie said the success rate of da Vinci procedures was much higher and recovery time much shorter compared to traditional surgery. The procedure itself was also faster.

 “I was devastated”

In another first, also on Thursday, urologist Dr Johan Venter who practises at Netcare Pretoria East Hospital performed his first nephrectomy, the complete removal of a kidney, on another patient also at Netcare Waterfall City Hospital. It was only the second nephrectomy done at a Netcare hospital with the da Vinci system.

“A complete success,” said Dr Venter after he removed 53-year-old Kevin Murphy’s right kidney, along with the fat and surrounding tissue in an operation lasting nearly three hours.

He used da Vinci technology to perform the procedure, but was unable to take the organ out through one of the small incisions made for the robotic arms, and had to make a larger incision for this purpose.

About two weeks ago Murphy noticed urine in his blood. After a visit to his doctor and some tests, the facilities manager was told he had a tumour in his kidney.

“I was devastated, I wasn’t in a happy space. I took it very hard at first,” Murphy said from his bed before the procedure on Thursday morning.

He said it was difficult coming to terms with having cancer and the realisation that he was going to lose part of his body.

“I am, however, very confident in Dr Venter’s ability and the advanced technology he’s using,” he said.

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Samsung unleashes the beast

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Most new smartphone releases of the past few years have been like cat-and-mouse games with consumers and each other. It has been as if morsels of cheese are thrown into the box to make it more interesting: a little extra camera here, a little more battery there, and incremental changes to size, speed (more) and weight (less). Each change moves the needle of innovation ever-so-slightly. Until we find ourselves, a few years later, with a handset that is revolutionary compared to six years ago, but an anti-climax relative to six months before.

And then came Samsung. Probably stung by the “incremental improvement” phrase that has become almost a cliché about new Galaxy devices, the Korean giant chose to unleash a beast last week.

The new Galaxy Note 9 is not only the biggest smartphone Samsung has ever released, but one of the biggest flagship handsets that can still be called a phone. With a 6.4” display, it suddenly competes with mini-tablets and gaming consoles, among other devices that had previously faced little contest from handsets.

It offers almost ever cutting edge introduced to the Galaxy S9 and S9+ smartphones earlier this year, including the market-leading f1.5 aperture lens, and an f2.4. telephoto lens, each weighing in at 12 Megapixels. The front lens is equally impressive, with an f1.7 aperture – first introduced on the Note 8 as the widest yet on a selfie camera.

So far, so S9. However, the Note range has always been set apart by its S Pen stylus, and each edition has added new features. Born as a mere pen that writes on screens, it evolved through the likes of pressure sensitivity, allowing for artistic expression, and cut-and-paste text with translation-on-the-fly.

(Click here or below to read more about the Samsung Galaxy S Pen stylus) Samsung Galaxy S9 Features)

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SA ride permit system ‘broken’

Despite the amendments to the National Land Transport Act, ALON LITS, General Manager, Uber in Sub Saharan Africa, believes that many premature given that the necessary, well-functioning systems and processes are not yet in place to make these regulatory changes viable.

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The spirit and intention of the amendments to the National Land Transport Act No 5  (NLTA), 2009 put forward by the Ministry of Transport are to be commended. It is especially pleasing that these amendments include ridesharing and e-hailing operators and drivers as legitimate participants in the country’s public transport system, which point to government’s willingness to embrace the changes and innovation taking place in the country’s transport industry.

However, there are aspects of the proposed amendments that are, at best, premature given that the necessary, well-functioning systems and processes are not yet in place to make these regulatory changes viable.

Of particular concern are the significant financial penalties that will need to be paid by ridesharing and e-hailing companies whose independent operators are found to be transporting passengers without a legal permit issued by the relevant local authority. These fines can be as high as R100 000 per driver operating without a permit. Apart from being an excessive penalty it is grossly unfair given that a large number of local authorities don’t yet have functioning permit issuing systems and processes in place.

The truth is that the operating permit issuance system in South Africa is effectively broken. The application and issuance processes for operating licenses are fundamentally flawed and subject to extensive delays, sometimes over a year in length.  This situation is exacerbated by the fact that it is very difficult for applicants whose permit applications haven’t yet been approved to get reasons for the extensive delays on the issuing of those permits.

Uber has had extensive first-hand experience with the frustratingly slow process of applying for these permits, with drivers often having to wait months and, in some cases more than a year, for their permits.

Sadly, there appears to be no sense of urgency amongst local authorities to prioritise fixing the flawed permit issuing systems and processes or address the large, and growing, backlogs of permit applications. As such, in order for the proposed stringent permit enforcement rules to be effective and fair to all role players, the long-standing issues around permit issuance first need to be addressed. At the very least, before the proposed legislation amendments are implemented, the National Transport Ministry needs to address the following issues:

  1. Efficient processes and systems must be put in place in all local authorities to allow drivers to easily apply for the operating permits they require
  2. Service level agreements need to be put in place with local authorities whereby they are required to assess applications and issue permits within the prescribed 60-day period.
  3. Local authorities need to be given deadlines by which their current permit application backlogs must be addressed to allow for faster processing of new applications once the amendments are promulgated.

If the Transport Ministry implements the proposed legislation amendments before ensuring that these permit issuance challenges are addressed, many drivers will be faced with the difficult choice of either having to operate illegally whilst awaiting their approved permits and risking significant fines and/or arrest, or stopping operations until they receive their permits, thereby losing what is, for many of them, their only source of income.

As such, if the Ministry of Transport is not able to address these particular challenges, it is only reasonable to ask it to reconsider this amendment and delay its implementation until the necessary infrastructure is in place to ensure it does not impact negatively on the country’s transport industry. The legislators must have been aware of the challenges of passing such a significant law, as the Amendment Bill allows for the Minister to use his discretion to delay implementation of provisions for up to 5 years.

Fair trade and healthy competition are the cornerstones of any effective and growing economy. However, these clauses (Section 66 (7) and Section 66A) of the NLTA amendment, as well as the proposal that regulators be given authority to define the geographic locations or zones in which vehicles may operate, are contrary to the spirit of both. As a good corporate citizen, Uber is committed to supplementing and enhancing South Africa’s national transport system and contributing positively to the industry. If passed into law without the revisions suggested above, these new amendments will limit our business and many others from playing the supportive roles we all can, and should, in growing the SA transport and tourism industries as well as many other key economic sectors.

What’s more, if passed as they currently stand, the amendments will effectively limit South African consumers from having full access to the range of convenient transport options they deserve; which has the potential to harm the reputation and credibility of the entire transport industry.

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