IN JUNE 2018, the Severance Hospital accomplished a ground-breaking record, following its motto of “The First & The Best.” For the first time in the world, the Severance Hospital had performed 20,000 robotic surgeries as a single-unit organization, vastly outperforming the second leading single-unit organization, which held the record of approximately 17,000 surgeries. By September 2018, the institution had conducted 2,152 robotic surgeries within the year and 20,855 in total. In an interview with The Yonsei Annals, Professor Han Woong-kyu, the Director of The Severance Robot and Minimally Invasive Surgery (MIS) Center, elaborated on the story behind such a remarkable accomplishment.
Past: the path to 20,000 surgeries
The Severance Robot and MIS Center began its first robotic surgery on July 15, 2005. Since then, the institution has showcased a rapid development: it took 3,042 days for it to perform a total of 10,000 robotic surgeries, and another 1,675 days to perform 10,000 more. Director Han attributed the accomplishment of such a record to all the medical fields within the Severance Hospital, emphasizing that “it was not simply one specific field or professor that demonstrated excellence, but rather, all of the fields equally developed together and proved their excellence both medically and academically.” Director Han added that the Severance Hospital presented its achievements across the globe, simultaneously promoting itself domestically, which led to the increase in the number of patients who wished to be treated by the Severance Robot and MIS Center.
This ground-breaking record was not an easy feat. There was much controversy surrounding the use of surgical robots at the time of their initial development. Director Han explained the short yet vibrant history of the surgical robots: “The surgical robot was first developed and researched after the mid-1990s in the United States. A company named Intuitive Surgical began to sell surgical robots in the early 2000s, which incited much controversy in the United States at the time.” He further elaborated on how before the introduction of robotic surgery, “the conventional surgery method was the laparoscopic surgery. Doctors would make a hole in the patient’s body, inject air to secure space for the surgery, and then conduct the surgery by inserting surgical instruments. Then robotic surgery was introduced, but the initial surgical robots’ performance did not live up to their high price. This created a heated debate among surgeons who performed laparoscopic surgeries.”
Despite the initial debate, the Severance Hospital adopted surgical robots in 2005 and has clinically utilized and developed them ever since. The pioneering movement began when the Severance Hospital opened a new branch in 2005. Director Han elaborated on the motive for this decision: “With funds provided by Mr. Louis Severance and the arrival of Dr. Allen, the Severance Hospital was founded as the first hospital in South Korea. The hospital was known as Che Joong-won at that time [in 1885]. Just as the Severance Hospital began with such history, the General Director of the Severance Hospital in 2005, Professor Ji Hoon-sang, along with other professors, imported the first-generation surgical robots, with the objective of developing the domestic medical field on the basis of new equipments.”
Present: ubiquitous application of robotic surgeries
Now, robotic surgery is actively used in a number of medical fields in the Severance Hospital. Among the 20,000 robotic surgeries that were carried out in the hospital, 35.5%, which translates to 7,100 performances, were for urological cancer surgeries; 31.1% were thyroid and endocrine surgeries, and 9% were gastrointestinal surgeries. In addition, surgical robots are also actively used in other areas including Departments of Obstetrics and Gynecology, Neurosurgery, Orthopedic Surgery, Chest Surgery and Cardiovascular Surgery. “These operations have proven to be highly successful, especially in terms of the minimal intrusion they inflict on the patients, allowing quick recovery with minimal incision lines,” added Director Han. Based on these performances, the Severance Robot and MIS Center is actively conducting additional research, publishing more than 350 academic journals on the topic of robotic surgery ever since its implementation at the Severance Hospital.
Additionally, the Severance Hospital is actively collaborating with companies that produce medical devices to further develop the use of surgical robots in Korea. Researching and developing domestic surgical robot technology is expected to greatly alleviate the high costs incurred from importing foreign devices, which in turn lessens the economic burden on patients. “For domestic surgical robots, a robot named Revo-i from Mee-re Co. obtained the first-ever domestic marketing permission early this year,” says Director Han. Furthermore, he revealed that the Severance Hospital has completed clinical trials in actual performances of cholecystectomy and prostatectomy with positive prospects.
In addition to active research and clinical trials, the Severance Hospital also focuses on nurturing future talents in the field of robotic surgery. The hospital established the Robotic Surgery Training Center in January 2008. From fundamental education on surgical robots to actual experimentation with the devices, the training sessions at the aforementioned center provide the students with valuable resources and opportunities tailored to the field of robotic surgery. Moreover, the Severance Hospital actively seeks to raise its competency in the field of robotic surgery by annually hosting the International Robot Surgery Live symposium. Inviting world-renowned surgeons from all over the globe, the hospital presents its discoveries and new sets of guidelines in the field of robotic surgery, while also encouraging domestic and foreign surgeons to lead active debates on various topics.
Future: Severance leading the development of robotic surgery
“We can expect active developments in surgical robots specialized to each field of surgery,” says Director Han. He further elaborated on numerous ways in which surgical robots can be developed. For example, he hinted at the possibility of implementing Artificial Intelligence (AI) in surgical devices. In realizing such advancements in Korea, Director Han showed his confidence in Severance’s physical and intellectual resources to lead elementary testing and clinical trials on newly developed surgical robots. “[To do so,] establishing an appropriate facility would be crucial,” says Director Han. The Severance Hospital thus plans to expand the Severance Robot and MIS Center to equip itself for an effective introduction of the latest surgical robots.
To keep up with the developing technology in surgical robots, the Severance Hospital also plans to establish a new set of training protocols in relation to robotic surgeries. In addition to the current training system, based on surgical simulations and animal and cadaveric testing, the hospital plans to adopt Virtual Reality (VR) technology into its training sessions to foster future-generation surgeons who specialize in robotic surgery. “Severance Hospital is building a new medical center [in the Yonsei International Campus at Songdo, Incheon], and establishing a robotic surgery training center is already one of our main agendas,” explained Director Han. As such, the Severance Robot and MIS Center hopes to support the Severance Hospital’s path to becoming a leading training facility that provides cutting-edge education for domestic and foreign medical personnel.
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“Severance Hospital of Yonsei University has established a dominant brand power in the field of robotic surgery,” comments Director Han. From conducting various research on robotic surgeries to developing new surgical methods and guidelines, Severance is creating and spearheading an unpaved path that is projected to revolutionize the South Korean medical industry. It is indeed leading the way—of medical technology—to the future.