Why Malaysia’s Sunway Medical Centre is Invested in the Latest Robotic Surgical System

10 March 2022

Despite its high cost, Sunway Medical Centre decided to bring in the latest Da Vinci Xi surgical system earlier this year – making them the first healthcare provider in Malaysia to do so. We speak with the hospital’s General Manager of Robotics Surgery and MIS Services to find out more.

While robotic surgery, or robot-assisted surgery, has been widely adopted by healthcare providers in the United States and Europe, the technology still remains relatively uncommon in Southeast Asia.

The region’s reluctance to adopt the technology can be seen from the fact that there are currently fewer than 40 robotic surgical systems in the whole of Southeast Asia – of which, more than half are accounted for by Thailand and Singapore.

Likewise, in Malaysia, the concept of robotic surgery continues to be viewed with a certain amount of uncertainty by the majority of healthcare providers in the country, often due to concerns over its high cost, reliability, and culpability.

One of the few Malaysian hospitals to have fully embraced robotic surgery, however, is Sunway Medical Centre.

Indeed, earlier this year, the hospital cemented their status as one of the trailblazers in Malaysia for robotics surgery by becoming the first healthcare provider in the country to acquire the latest da Vinci Xi surgical system, to add on to the third-generation da Vinci Si system which they acquired five years ago.

The fourth-generation da Vinci surgical system brings about a whole host of new functionalities as compared to its previous three predecessors, such as a new overhead instrument arm architecture which allows anatomical access from virtually any position, the ability to attach the endoscope to any of its four arms, as well as smaller, thinner arms, with newly designed joints that offer a greater range of motion.

In addition, the da Vinci Xi surgical system is equipped with a Firefly (fluorescence imaging) system, and also boasts an integrated generator.

All of these come on top of the core components da Vinci surgical systems, including high-resolution 3D vision, EndoWrist instrumentation, and intuitive motion with synchronised hand-eye movement.

Speaking to Hospital Management Asia (HMA), the General Manager of Robotics Surgery and MIS Services at Sunway Medical Centre, Helen Ng, explained that the decision to purchase the da Vinci Xi surgical system was made because they believed its benefits – for both patients and their staff – outweighed the costs.

"We saw the need to invest in the new system because we are moving towards becoming a quaternary service provider, and we have been getting more referrals for complex robotic surgeries” said Ms Ng. “Many of these surgeries require multi-quadrant access, which the new da Vinci XI system allows for, so our surgeons are now better able to perform these procedures.

“As one of the few hospitals in Malaysia which specialises in robotic surgeries, we have the necessary expertise to operate the new system, so it made sense overall for us to get it.”

While admitting that the cost for robotic surgeries was “higher” than other types of surgeries, Ms Ng claims it is still a worthwhile investment once the benefits it brings is taken into account.

“If you do a head-to-head comparison of cost, then yes, the charges for robotic surgery is higher than that of other surgeries,” said Ms Ng. “But what needs to also be highlighted is that it helps to save on a lot of hidden costs associated with regular surgeries.

“For example, statistics have shown that with robotic surgeries, the average length of stay for patients is generally shorter. The chances of suffering from post-surgical complications, which may result in readmissions or infections, are also significantly reduced. Overall, patients recover much faster, and as such, are able to return to work earlier.”

Ms Ng added that she has seen an increase in the demand for robotic surgeries at Sunway Medical Centre in recent years, with more patients starting to better understand its benefits.

“Most of the patients who come to Sunway Medical Centre for surgery have already done their homework,” said Ms Ng. “So when they come to Sunway, it’s because they’re looking specifically for robotic surgery. They’ve done their research on the internet…because robotic surgery is very common overseas, there’s a lot of in-depth information out there, and so they come to realise the advantages of robotic surgeries. Usually, the only thing that might give them pause for thought are monetary concerns.”

While tipping robotic surgeries to play a huge role in the future of Southeast Asia’s healthcare, Ms Ng acknowledged that there are still several challenges to overcome before the majority of healthcare providers in the region will accept this technology.

One key issue, in particular, is the unwillingness of insurance companies to provide coverage for robotic surgeries. As such, patients who opt for such procedures often have to pay the bill in full – at best, they will still have to co-pay for the surgery.

That is why Ms Ng hopes more hospitals in the region will come on board the robotic surgery train, so that it will be viewed as norm in the healthcare sector, rather than as an exception.

“Even though the first robotic surgical system was installed in Malaysia almost two decades ago, it is still not widely accepted by insurance companies due to a lack of awareness and knowledge,” Ms Ng elaborated.

“The common perception of robotic surgeries that it is meant only for certain types of procedures, like prostatectomy or urology. But with the advances in technology, there are now a whole suite or procedures that can be performed using robotic surgical systems.

“So, we encourage more healthcare providers to utilise robotic surgical systems…with more healthcare providers offering robotic surgeries, there will be an increase in the data and clinical evidence, and this can go towards convincing insurance companies that robotic surgical methods are better than others. When that happens, and robotic surgeries become a common occurrence, then perhaps insurance companies will finally be willing to provide full coverage for these procedures.”

Nonetheless, Ms Ng concedes that robotic surgery might not be suitable for every hospital.

She explained: “If you are a smaller hospital…then I would say that there is no need to invest in robotic surgery, because you won’t have enough disciplines to sustain the programme.

“But if your hospital is big, and you offer tertiary or quaternary services, with multiple-disciplined doctors to back you up, then equipping your facility robotic surgical capabilities is definitely something to consider, especially if you have a sizeable patient load.

“By doing so, you can differentiate yourself from the rest of the hospitals and enhance your branding as a modern healthcare provider that utilises the latest technologies to improve patient outcomes.”

Ms Ng, however, was also keen to emphasise that a robotic surgery programme can only succeed if the hospital fully commits to it.

“Robotic surgery can only succeed with a dedicated team, consisting of hospital administrators, surgeons, nurses, and marketers,” said Ms Ng. “The entire team needs to create a standard of practice, compile data, and enable continuous training to ensure team competency and good surgical outcomes.

“So, the hospital must be serious about wanting to make the programme a success. Hopefully, with more surgical robots on board, more patients will be able to access these services at more affordable costs.”

Source: Hospital Management Asia