24 What prompted the formation of the South African Urology Association Robotic Surgery Group and why has it taken so long? It has been recognised for a while now that there's a need to address issues in relation to robotic surgery. We were approached by the South African Urology Association (SAUA) for expert guidance pertaining to robotic surgical issues. And at the same time healthcare funders were looking for advice relating to various aspects of robotic surgery and accreditation of robotics surgeons. The timing was therefore perfect for the formation of this expert group. I should add that the 7 group members were all elected by their robotic surgeon peer group. Given that robotic surgery is used by multiple specialities, how will certication be managed? Although urologists were the pioneers of robotic surgery, there is now expansion into colorectal and general surgery, as well as uro-gynaecology/pelvic oor surgery. Currently the ofcial training of new robotic surgeons is still managed by the local distributor. We are currently in discussions with various interested parties on taking on an oversight role of robotic accreditation. I am not aware of how other specialities are managing this. Until recently, the da Vinci Surgical System has been the only robot available in South Africa. How will training and certication be managed when multiple systems from different companies become available? The new distributors will likely provide training on their robots, while certication will probably be the same as for Da Vinci. There are now robots available at Tygerberg and Groote Schuur in addition to the 9 at private facilities. Do you think there will ever be a time when all urologists in South Africa will be trained and certied to do robotic surgery as part of their specialist training? This would be highly desirable in the long term, although I believe is still many years away in South Africa. The fact remains that only two of seven medical schools have robotic platforms. While the capital costs of acquiring a new robot are high, the revenue consequences and maintenance are the major costs. With more fundamental healthcare cost pressures, this situation is unlikely to change in the foreseeable future. Robotic surgical training is therefore likely going to remain a subspecialist eld, although the opportunity to establish Fellowships for robotic training is a possibility. Given that high volume surgeons practising in high volume centres tend to have the best outcomes, do you believe that robotic surgery should be restricted to these centres ? Or alternatively that information on the number of procedures that a surgeon has performed should be made available to members of the public to enable them to make an informed decision? Publication of surgeon outcomes has for many years been a subject of much controversy and debate. The UK has done this, publishing outcomes such as 30 day mortality, complication and readmission rates, for a range of procedures. However, to achieve this is a monumental task in data collection, and carries considerable cost which somebody has to pay for. Surgeons generally only agree to this if every surgeon and every speciality participates. The practical implications of this are enormous. So while it sounds easy and very patient-centric, it is not currently achievable in South Africa. Will we ever have a South African Society of Robotic Surgeons? Since the election and establishment of this robotic interest group, it's become clear that there is a need for a society of this nature. How and where it sits in relation to the SAUA is as yet unclear and open for discussion. My opinion is that it probably best remains under the umbrella of the SAUA. UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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