MEDI1TV Afrique : #MediUP / Le Maroc bat le record mondial de la chirurgie à distance - 30/11/2024
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00:30of the history of robotic surgery, with a medical prowess that once again shows that Morocco is a land of innovation.
00:37Recently, from Shanghai, where he was in China, he was able to perform, with the help of a robot,
00:44a remote operation of a prostate cancer in a patient in Morocco,
00:48at a record distance of 12,000 km, a world premiere.
00:53Younes Halal is our guest, he is live from Nice with us.
01:02Younes Halal, hello and thank you for accepting our invitation.
01:09Hello and thank you very much for inviting me, it is always a pleasure for me to discuss with you
01:15this incredible prowess that fascinates me and fascinates all our customers.
01:24So, Dr. Younes, during this operation, I remind you, you were in Shanghai, in China,
01:32your patient in Casablanca.
01:35How did you ensure such precision in surgical gestures at a distance despite the 12,000 km that separated you?
01:44So, indeed, it was an incredible challenge because we were going to break the world record
01:51of the largest distance ever achieved for a remote robotic surgery,
01:59since the surgeon was in Shanghai, China, and the patient was in Casablanca.
02:05So, this intervention has raised several challenges,
02:08and to be able to ensure the necessary precision for this kind of intervention,
02:14we needed, first of all, a high-performance robotic platform.
02:20It was an Asian robot, the Tumai robot from Medbot,
02:24which could offer us this possibility of remote surgery.
02:28And we also needed an ultra-reliable connection with low latency,
02:34a network stability, and a high-speed connection,
02:40which allows a perfect synchronization between the surgeon's gestures, which are carried out in Shanghai,
02:46and the actions of the robot, which executes the orders given by the surgeon at will,
02:52and this, practically instantaneously.
02:56You were in Shanghai, but you also had a team in Casablanca, made up of various specialists.
03:03What was the precise role during the operation? How was the communication done?
03:09That's a very good question, because the local teams
03:15have a key role in the success of the intervention.
03:17Of course, the surgeon was remote,
03:21but the teams on site had a crucial role.
03:25First of all, there was a whole team of urological surgeons.
03:29There was the patient's urological surgeon,
03:31there was another urological surgeon, an expert in robotic surgery,
03:36who, in case of emergency, if there was a technical incident,
03:39could take over and lead this surgical intervention.
03:44There was a team of anesthetists, because anesthesia is also very important.
03:48Robotic surgery requires some adjustments in terms of anesthesia.
03:52And there were also nurses who were specialized in robotic surgery
03:57and whose role is very, very important.
04:00So that's the first element.
04:02The second element, in fact, the local team was made up of technicians and engineers
04:08whose role was to ensure that the entire procedure was carried out
04:14without any technical incident, which is precisely linked to this cutting-edge technology
04:19that we had set up to carry out this surgical intervention.
04:23So, with this kind of remote operation,
04:27every second counts.
04:29How did you manage the question of real time?
04:33Were there times when latency could have been a problem?
04:38And how did you react?
04:41So, this intervention required a meticulous preparation
04:47for several months to ensure that all the stars were aligned
04:52so that the intervention was carried out in the best conditions.
04:55And one of the conditions and one of the major challenges
04:59is the network latency.
05:01In fact, the robot must execute the order given by the surgeon
05:08instantly, without any lag.
05:12So, before the intervention, we had to carry out several tests
05:17to see what was the optimal routine or path
05:22of the connection to have the lowest latency possible.
05:26So, we were able to have a latency of less than 200 milliseconds.
05:32And for this kind of small latency, in fact,
05:35the perception is really very, very low.
05:38And we can carry out this intervention as if we were carrying out an intervention
05:42in the usual conditions.
05:46And of course, we had a contingency plan.
05:48That is to say that if there was ever the slightest problem
05:51where we had a latency that could exceed 250 or 300,
05:56we had a plan to ensure that the intervention was carried out
06:00precisely by the local team.
06:02And fortunately, we didn't have to do that.
06:04We had network stability
06:07over the entire duration of the surgical intervention.
06:11And precisely, how long did it last?
06:15So, the surgical intervention lasted a little longer than usual.
06:21It lasted 2 hours and 30 minutes, in fact.
06:24It didn't last that long,
06:26because in fact, everything was done to make it happen
06:28as if the intervention was being carried out in the usual methods.
06:32It lasted longer because it was a patient who was rather young
06:36and needed to be preserved.
06:39In fact, the intervention we carried out was a radical prostatectomy,
06:43an ablation of the prostate for a prostate cancer.
06:47And around the prostate, we had nerves that are very, very important,
06:51close to the prostate, which are the nerves of the erection.
06:53And at all costs, these nerves had to be preserved
06:56to ensure the patient a perfect erection after the intervention.
07:03And that's why it lasted a little longer,
07:05because it had to be even more meticulous than usual.
07:09So, if this medical feat could have been achieved,
07:12it's also because behind it, there is a pioneering structure
07:15in prevention and the fight against cancer in Morocco.
07:19I'm talking to you about Ancora de Groupe.
07:21What was its role in the preparation and realization
07:26of this world premiere in terms of distance?
07:30So, the Ancora de Groupe group played a crucial role
07:34and a key role in the success of this intervention.
07:38You know, thanks to this group,
07:42we also carried out the first robotic surgery interventions in Morocco,
07:48in North Africa and even in Africa, outside South Africa.
07:51And it was this group that believed in this technology
07:55and facilitated everything, already for the acquisition of the surgical robot.
08:00And then, as they are pioneers in everything that is innovation in cancerology,
08:06they did not hesitate for a moment when I offered them
08:10this surgery that was going to be placed in Morocco.
08:15And that's really a pride for all of us,
08:17as leaders in terms of medical innovation worldwide.
08:20And that's really very important.
08:22How do you explain that this world premiere in terms of distance
08:27has been carried out in Morocco?
08:29What are the benefits of the Kingdom today
08:32in terms of medical research and technology?
08:36So, in fact, why not Morocco?
08:39At one time, we were a little less advanced
08:43in terms of medicine and in terms of innovation.
08:46But over the past few years, and thanks to the political will
08:49and especially thanks to groups like the Ancora de Groupe,
08:52which are really ahead of the curve in terms of medical innovation,
08:57well, the whole field was ready, was sharp
09:01to be able to develop these technologies,
09:03whether on a medical level or on a medical skill level.
09:07Because, as you know, the Ancora de Groupe
09:11has called on my services.
09:13I'm going to join this group to develop even more
09:16this excellence surgery in Morocco.
09:19And then, in fact, they organized everything,
09:21whether it's the training of paramedical teams,
09:23whether it's the training of their technicians
09:25or whether it's everything that is medical-surgical infrastructure.
09:29So the role was really crucial.
09:32And what are the costs associated with this type of intervention now?
09:37How do we make this technology accessible
09:40to as many patients as possible suffering from prostate cancer?
09:46So, indeed, it's a technology that's modern, that's expensive.
09:52The cost, in fact, mainly lies in the cost of acquiring the surgical robot,
09:57which can be quite expensive, and also the cost of maintenance.
10:01So it's the fixed costs, in fact, that are the most important.
10:05And so, the more surgical interventions we carry out,
10:08the more we're going to spread these fixed costs
10:11over this set of interventions that are carried out.
10:14And so the cost of the intervention will be reduced
10:17over time and with the development of this activity.
10:20Knowing that there is a very, very important issue,
10:22we must not forget it.
10:24Robotic surgery, for the results of our patients,
10:30it allows for less pain, less bleeding.
10:34It allows patients to leave the hospital on the same day,
10:38or even the day after the intervention,
10:40and they will be able to resume their activities,
10:43of course, physical, social, and especially professional, very quickly.
10:47On the other hand, there will be less complications,
10:51so less care consumption, less rehospitalization.
10:55And so, ultimately, when we compare the global cost
10:59for the community or for a health system,
11:02the use of the surgical robot and remote robotic surgery,
11:06will ultimately be much cheaper than conventional surgery.
11:12And that's really very, very important to keep in mind.
11:15And what are the ethical issues related to this telesurgery?
11:20How to guarantee consent,
11:23how to enlighten patients and their safety?
11:27So, this is a very, very important question,
11:30because there are, of course,
11:32in the face of all new technology,
11:34ethical questions that must be asked.
11:37Of course, as with any conventional surgery,
11:40it is necessary to ensure that the patient's consent is obtained.
11:44He must know the modalities, the risk of complications,
11:49the results of the surgical intervention.
11:52It is also necessary to ensure, and this is very, very important,
11:55especially in terms of remote surgery,
12:00to ensure the safety of the patient's data,
12:03since the patient's data are confidential.
12:05And this has been ensured
12:08thanks to a very important fencing system
12:13and advanced parts that could have been used,
12:16especially during this first intervention,
12:18to ensure the safety of the data.
12:20And of course, as with any new surgery,
12:23any new technology,
12:25an ethical committee must work on this issue
12:29to generate a conduct to be adhered to
12:33that is regulatory and precise
12:36to regulate this type of surgical intervention
12:38to a more global scale.
12:40Younes Saharal, thank you.
12:41Thank you for all these clarifications.
12:43Thank you for answering our questions.
12:46Morocco is proud of you, so is Africa.
12:51Thank you very much for your invitation.
12:55This concludes this issue of Mediappe.
13:00We thank the technical and reactionary teams
13:02who have contributed to its realization.
13:04Wherever you are, take care of yourself
13:06and go to the end of your dreams.
13:08Never give up.