Hong Kong’s Chinese University successfully completes clinical trials of ‘single-port’ robotic arm for surgery – and patients find system a cut above as well

By the time she was 76, Cheng Choi-yuk had had enough of hospital visits.

She was diagnosed with nasopharyngeal cancer in 2005. Then she suffered a stroke. In July 2017, a malignant tumour was found under her tongue as a result of the radiotherapy treatment for her previous cancer.

Once more Cheng was forced to go under the knife.

“I thought to myself at the time: I was nearly 80, had undergone so many surgeries already, and suffered from cancer and a stroke. I was really on the fence on this one,” she said.

That was when Cheng, now 78, was told she had a chance to be one of the few patients in the world to undergo minimally invasive surgery with a new “single-port” robotic system as part of clinical trials at Chinese University’s faculty of medicine.

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The one-year feasibility and safety trial between 2016 and 2017 – on 63 patients undergoing head and neck, urology or colorectal surgery – was successfully completed without complications. Cheng was one of these patients.

“The robotic arm of the new system allows truly minimally invasive access to previously more difficult-to-access sites,” said Dr Jason Chan King-yuen, assistant professor of otorhinolaryngology at the faculty.

With a single-port system, a robotic arm carrying just three instruments and a high-definition 3D camera enters the body through one site, requiring a much smaller incision.

Earlier “multi-port” systems were clunky and space-consuming. The four-arm system did not work well for more complicated procedures in narrow spaces, and the arms had a tendency to interfere with one another. At least four different keyhole incisions had to be made.

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“We believe the advance in the technology offers a platform on which surgeons can develop novel approaches to handling cases, with minimal invasiveness, to facilitate patient recovery and minimise morbidity,” Chan added.

Alex Chuk, 60, also agreed to be part of the trial after a cancerous tumour was found just above his colon and had to be removed.

“They told me robotic surgery would be more precise and promote better recovery. I was quite surprised and glad this option was available,” he said. “But my first impression was of some kind of android doing the operation. I had no clue.”

Chuk was able to stop taking painkillers the night after surgery and left hospital in a little over a week. The 4cm scar above his belly button is barely visible.

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Minimally invasive surgeries aim to minimise the size of incisions to help reduce patients’ trauma and pain, enabling quicker recovery and cutting the risk of infection. They have been carried out at Prince of Wales Hospital – Chinese University’s teaching hospital in Sha Tin – since as far back as 1990.

Surgeons have been performing them with the help of robots since 2005, mainly for removal of gallstones, and tumours of the gastrointestinal tract, adrenal gland and even in the liver.

While multi-port systems are still being used, clinicians and researchers at the hospital are hoping for full clinical application of single-port ones soon.

“Our clinical trial results have provided valuable data for [their] introduction. Certainly the system has a lot of potential applications in other specialities and more patients can benefit from the broader use,” said Professor Philip Chiu Wai-yan, director of the university’s Minimally Invasive Surgical Skills Centre.

The only obstacle is cost. One US-made da Vinci SP single-port system – the one loaned for the trial – is believed to cost HK$30 million to HK$40 million.