Robotic surgery set to transform medical care in the Gulf

The Gulf region, and particularly Saudi Arabia, has become a world leader in the application of medical robotics. (Shutterstock)
Updated 10 July 2019
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Robotic surgery set to transform medical care in the Gulf

  • Technological advancements helping surgeons perform complex procedures using minimally invasive techniques
  • In robot-assisted surgery, the surgeon sits at a console and views the patient's target anatomy in HD 3D image

DUBAI: When it comes to man versus machine, many industries, including medical science, are at a critical juncture. 

Advancements in technology are creating a world where robots are performing tasks with speed and efficiency unmatched by their human counterparts.

Increasingly, robots are becoming a familiar presence in operating theaters, especially in the Gulf. Experts predict that the region could become the leader in the field of robotic surgery.

In June, Johns Hopkins Aramco Healthcare (JHAH) — the result of a joint venture between Saudi Aramco and Johns Hopkins Medicine — became the first hospital in the Kingdom to perform a robot-assisted hysterectomy.

“The new trend in hospitals that provide the most up-to-date medical services to their patients is to do surgical procedures using minimally invasive techniques,” Dr. Tareq Al-Tartir, a urologic oncologist and head of JHAH’s robotics program, told Arab News.

“Robotic surgery has revolutionized the way surgery is being conducted, and now many hospitals in Saudi Arabia have adopted this technique.”

Saudi surgeons are conducting increasingly complex procedures using the Da Vinci surgical system, said Al-Tartir.

The device features a set of three or four robotic arms remotely controlled by a human surgeon. 

IN NUMBERS

  • 2002 - The year robotic surgery was introduced. 2003 - The year a surgical robot was first brought to Saudi Arabia.
  • 44 - Da Vinci surgical systems installed in the Middle East.
  • 19 - Da Vinci surgical systems (pictured below) installed in Saudi Arabia.
  • 930 - Documented robot-assisted procedures performed in Saudi Arabia in 2004-2010.
  • 60% - Jump in robot-assisted procedures in 2011-2017.

Using the Da Vinci system, operations can be done with just a few incisions and the utmost precision, with less bleeding, faster healing and reduced risks of infection.

“At the beginning, robotic surgery was installed in a few institutes in the Middle East. The expertise needed to perform the procedures using the robotic machine developed with time. Currently, more institutes and more procedures are using the machine,” said Al-Tartir.

“The JHAH robotic surgery program is considered among the leading ones in the Middle East using this high-tech machine.” 

In the JHAH case last month, Al-Tartir said, the “hands” of the Da Vinci surgical system used to perform the hysterectomy allowed a high degree of dexterity. 

Thus surgeons had the ability to operate in very tight spaces, for example the pelvis, which would otherwise only be accessible through open surgery with long incisions.

During such surgery, the surgeon sits at a console and views the patient via high-definition 3D imagery, and manipulates the robotic arms through their own hands and wrists.

The system can be used on a range of minimally invasive surgeries, such as cardiac, urologic (including prostate, bladder and kidney cancers) and thoracic surgery.

JHAH has also carried out the first robot-assisted operations in the Kingdom to remove cancerous tumors. 

Its doctors, based in Saudi Arabia’s Eastern Province, were also the first to perform bariatric surgery and treat gastroesophageal reflux using similar techniques.

Al-Tartir said thanks to the JHAH’s program and the willingness of the Saudi government to invest in medical care as part of its Vision 2030 reforms, the Kingdom is capable of putting the Gulf region on the map of robotic-assisted surgery.

“The ability of young surgeons to digest this new technology is a well-known fact, and the world trend now is to move into digital transformation. Medicine in general, and surgery in particular, is part of that trend,” he added.

“In the coming few years, robotic surgery will be the new gold standard in doing surgical procedures, and countries like Saudi Arabia, which invests a significant part of its income on the health of its citizens, can become a leader in this field.”

According to a study titled “The Development of Robotic Surgery in the Middle East,” led by King Saud University, robotic surgery started gaining a foothold in the region in 2003, about three years after Da Vinci became the first robotic surgery system approved by the US Food and Drug Administration for general laparoscopic surgery. Saudi Arabia was the earliest adopter of the technology in the Middle East.

The Kingdom already has 14 Da Vinci surgical systems, each coming with a price tag of more than $2 million, Al-Tartir said. 

“Surgeons across all regions in Saudi Arabia are putting all their efforts into using this technique,” he added.

“The benefits include better magnification with better visualization, low risk of blood loss, lessened need for blood transfusions, less pain and scarring because of the use of small incisions to perform complex surgical procedures, reduced hospital stays and speedier recovery.”

While Da Vinci surgery, developed by the US company Intuitive Surgical, is considered a medical leader, many big tech companies are developing their own autonomous systems.

CMR Surgical, a British medical device company, is rolling out its offering “Versius” which, like other surgical robots, performs laparoscopic surgeries.

Surgical robotics are “a key enabler for increasing access to minimal access surgery and keyhole surgery,” Dr. Mark Slack, chief medical officer at CMR Surgical, told Arab News.

But despite its numerous proven benefits over open surgery, this technique is utilized in less than half of all procedures worldwide.

“This means many thousands of people each year are more likely to be subjected to the disadvantages of open surgery, including increased pain, surgical site infections and a range of surgical complications. This also creates a burden of long stays in hospital and significantly longer recovery times,” Slack said.

The scope for countries willing to invest in the robotic medical field is endless. But though the march of technology may be relentless, surgeons need not worry about robots taking their jobs. 

“Surgical robotics, including Versius, have been designed to be a tool to be used by surgeons, and therefore the relationship between surgeon and patient doesn’t change,” Slack added.

Dr. Rakesh Suri, CEO of the Cleveland Clinic Abu Dhabi (CCAD) and head of its robotic cardiac surgery program, said a common misconception is that robotic surgery does not involve the surgeon.

“In fact, the robot acts as an extension of the surgeon, enabling us to perform operations in a way that simply wouldn’t be possible with human hands. The robot allows us to manipulate surgical tools with unparalleled precision,” he told Arab News.

“Robotic surgery is of most benefit in densely packed and awkward areas of the body that present significant risks through traditional approaches,” he said.

“Because it’s minimally invasive and the robotic arms are so precise, we can access specific sites with minimal damage to the surrounding area,” he added.

“This helps patients recover significantly faster with fewer complications, improving outcomes and costs for health systems as a whole.”

Currently, robotically assisted procedures are most commonly used in urological procedures, said Slack. 

But forecasts predict strong expansion across gynaecology, general surgery and upper gastrointestinal surgery, meaning many now-common surgical procedures could soon become obsolete.

Suri said robotics play a key role in dealing with some of the leading health care challenges in the Middle East.

“As we deal with rising rates of cardiovascular disease, obesity and cancer, robotic surgery will only become more important in offering patients the best possible outcomes, and eliminate the need for patients to travel abroad for treatment,” he added.

“To meet that challenge head on, it’s vital that the Middle East is able to build on its potential to become a leader in the field of robotic surgery globally.”

 


Saudi Arabian history on display at Abu Dhabi Book Fair 

Updated 26 April 2024
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Saudi Arabian history on display at Abu Dhabi Book Fair 

  • Selections from London-based rare-book dealer Peter Harrington’s offering at the UAE fair 

‘Ibn Saud press photograph’ 

According to notes from rare books specialists from Peter Harrington’s team, this image from archives of The Times newspaper was taken in what was then called Hejaz, following a “critical and secretive meeting between (founder of Saudi Arabia) Ibn Saud (center) and the British representative Sir Gilbert Clayton (left) — one of a pivotal series of negotiations which led to the Treaty of Jeddah in May 1927.” The two discussed “various outstanding questions affecting the relations of the Kingdom of the Hejaz and Nejd with the neighboring states of Iraq and Transjordan” to help determine the northern borders of Saudi Arabia. “Discussions over the borders were protracted and complex, with the towns of Maʿan and Kaf the object of particularly intense debate,” the notes state. 

‘Pilgrimage to El-Medinah and Mecca’ by Richard F. Burton 

In this three-volume first edition, complete with illustrations, of “one of the most extraordinary travel narratives of the 19th century,” the British explorer, writer and polyglot Richard Francis Burton recounts his Hajj journey, made “in complete disguise as a Muslim native of the Middle East” at a time when fewer than half-a-dozen Europeans had made the pilgrimage — forbidden to non-Muslims. “It surpassed all preceding Western accounts of the holy cities of Islam, made Burton famous, and became a classic of travel literature, described by T. E. Lawrence as ‘a most remarkable work of the highest value,’” the team from Peter Harrington note. In Makkah, Burton performed all the rites of the pilgrimage and his subterfuge remained undiscovered. 

‘Map and Overview Presenting the Hejaz Railway Route’ 

This map from 1903 depicts the route of the ambitious Hejaz Railway project. It “depicts a very broad area, extending from just north of Hama, Syria, all the way south a little way past Makkah, in the Hejaz; it covers most of Syria, all of Palestine, the Sinai Peninsula, the Suez Canal, and all the north-western Arabian Peninsula,” Peter Harrington’s rare book experts write. “It clearly delineates those parts of the railway that are in place and those under construction … with each station labelled. Additionally, it depicts the two alternative routes proposed for extending the line to Makkah, employing broken lines, while another line traces the proposed (but unrealized) route of a rail line from Makkah to Jeddah. The map also labels important roads and caravan routes.” 

Four years after this map was published, the book seller’s notes state, the railway reached AlUla, which is not marked on this map, although Mada’in Salah (now Hegra) is, which today is the site of one of two museums dedicated to the Hejaz Railway.  

By 1908, the railway had reached Madinah, where, the notes state, “for various political reasons, it had to be terminated.” Nevertheless, they continue, “until the outbreak of the First World War, it allowed hundreds of thousands of pilgrims to make the Hajj in safety and with relative ease.” 

‘Material from the library of Peter O’Toole by T.E. Lawrence’ 

Billed by Peter Harrington as an “insightful archive, spanning Lawrence’s transformation from man of the moment to unwilling celebrity, from the library of Peter O’Toole, whose breakthrough portrayal in David Lean’s 1962 biopic still shapes perceptions of the famous Arabist. Autograph material from Lawrence is always highly prized, but rarely is its provenance so apposite.” 

The centerpiece of the material is a photograph and an unpublished letter written by Lawrence (who became known as Lawrence of Arabia following his journeys across the Middle East, including modern-day Saudi Arabia), framed as a piece and gifted to the English actor who played Lawrence in the aforementioned biopic by his wife, Sian, and a friend not long before the premiere of the movie. The letter makes clear Lawrence’s difficult relationship with his celebrity, and is cutting about his own book, “The Seven Pillars of Wisdom,” saying that he did not own a copy himself (“No man yet has ever wanted to read his own book”) but that his mother and “little brother” did, “and that is plenty for the family. Nobody reads it: it is worth too much money. ... It is a rotten book, you know.” 

‘Oil Region in the Desert of Saudi Arabia’ 

This 1950 image, “after a painting by the German artist Michael Mathias Kiefer,” is one of a series of geographical pictures intended for use in the curriculum of German schools. “The painting juxtaposes Arab figures in traditional garb with images of drilling rigs, a lorry, and oil storage tanks, creating a strikingly orientalist image,” Peter Harrington’s notes state. “In the middle of the composition, a pipeline bisects the image, a forceful reminder of the centrality of oil to the modern Saudi Arabian economy. In the foreground, members of a group of travelers, possibly intended to be Bedouins, rest on a carpet and let their camels drink from a water tank. Away in the background, before a distant oasis, more travelers arrive at a campsite, their camels heavily laden. Their destination is the oil infrastructure that crowds the right of the image.” 


Recipes for Success: Chef Antonio De Crecchio offers advice and a gnocchi with duck ragu recipe

Updated 26 April 2024
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Recipes for Success: Chef Antonio De Crecchio offers advice and a gnocchi with duck ragu recipe

DUBAI: Antonio De Crecchio began his career back in 2006, working as a pizza chef in Naples, Italy. He was, he says, just 14 years old. 

“I’ve always loved food and cooking, but that’s when I truly fell in love with cooking,” he tells Arab News. “My first boss was tough on me, but it taught me a lot about handling the job and pushing myself to get better.” 

Antonio De Crecchio began his career back in 2006. (Supplied)

He continued to work as a pizza chef at various Rossopomodoro outlets across the UK, including London, Birmingham, and Newcastle, before returning to Italy to lead the team at Rossopomodoro in Torino and Milano. In 2019, he moved to the UAE, taking a job as pizza chef at Antica Pizzeria da Michele in Dubai. He is currently executive chef of Amò at Via Toledo in Dubai’s Address Beach Resort.  

“Working here has been emotional for me,” he says. “After spending many years in a casual dining restaurant, opening a fine dining restaurant feels like reaching a higher level,” he said. 

Here, De Crecchio — affectionately known as Chef Toto — discusses tips for amateur chefs, his love for Italian cuisine, and his most challenging dish. 

Amò is at Via Toledo in Dubai’s Address Beach Resort. (Supplied)

What’s your top tip for amateur chefs cooking at home? 

Invest in a Bimby. It’s a great tool for making pizza dough, ensuring that the result matches what you’d get at a restaurant. Plus it saves a lot of time, allowing you to focus on other tasks. Making dough correctly requires a lot of experience, so having the right equipment can make a big difference. 

When you go out to eat, do you find yourself critiquing the food?  

Yes. Often. 

And what’s the most common issue that you find in other restaurants? 

One thing I notice, especially with Italian food, is that the pasta is not always cooked al dente, as it should be. This can be challenging for me because I have a strong preference for the traditional Italian food that my grandma used to make. 

Tiramisu. (Supplied)

 

What’s your favorite cuisine when you go out? 

My favorite cuisine is Italian, especially pasta. It reminds me of my home country and brings back fond memories. 

What customer request or behavior most annoys you? 

The requests that annoy me the most are when they ask for pasta with chicken and pizza with pineapple. 

What’s your favorite dish to cook?  

My favorite dish to cook is pasta, because it reminds me of Sundays back home when my mom used to prepare it for our family lunches. 

Pizza Chiena, a savory pie. (Supplied)

 

What’s the most difficult dish for you to get right? 

The most challenging dish for me to perfect is our egg dish. It requires cooking at a low temperature to maintain a soft interior, and achieving the right texture for the foam that accompanies it is crucial. If you don’t achieve the exact balance, then the dish loses its identity. 

As a head chef, what are you like? Are you a disciplinarian? Or are you more laid back?  

As a head chef, I prioritize discipline, but I avoid shouting at my staff. In the kitchen, maintaining both discipline and empathy with my team is essential for success. 

Chef Antonio’s gnocchi with duck ragu  

Gnocchi with Duck Ragu Recipe. (Supplied)

INGREDIENTS 

1kg potatoes; 100g parmesan cheese; 15g salt; 1 egg; 375g all-purpose flour; 1kg duck legs; 250g carrots, chopped; 250g white onion, chopped; 250g celery, chopped 

INSTRUCTIONS 

For the duck ragu: 

1. Heat a pot on the stove until it reaches smoking point. Add blended oil. 

2. Season the skin side of the duck legs with salt. Sear them until the outer surface of the meat is scorched, then transfer to a deep tray, cover them with their fat and place in the oven at 150°C for two hours. 

3. In the same pot used for searing, add the celery, white onion and carrots to the duck fat and deglaze with approximately 4 liters of chicken stock. 

4. Bring the stock to a boil, then slowly add each leg to the boiling stock. 

5. Transfer the stock and duck legs into a large oven dish and heat in the oven at 160°C for two hours. 

6. Remove the dish from the oven, take the duck legs out of the liquid and gently pull the meat from the duck legs, setting it aside. 

7. Transfer the remaining liquid to a pot and reduce for one hour. 

8. Allow the reduction to cool down, then mix it with the duck meat to prepare the duck ragu. 

For the gnocchi 

1. Steam the potatoes until tender, then mash. 

2. Add grated parmesan cheese, salt, egg, and flour, and combine to form a dough. 

3. Roll the dough into ropes and cut it into small pieces to form gnocchi. 

4. Bring a pot of salted water to a boil, then cook the gnocchi until they float to the surface. Remove and set aside. 

5. Toast the cooked gnocchi with butter and additional parmesan cheese in a pan until lightly browned. 

6. Plate the gnocchi and top with the prepared duck ragu. 


Two Saudi hotels listed in Conde Nast’s Hot List of new openings from the last year

Updated 25 April 2024
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Two Saudi hotels listed in Conde Nast’s Hot List of new openings from the last year

DUBAI: For those planning their next staycation, two hotels in Saudi Arabia have found a spot in Conde Nast’s prestigious annual Hot List, with one of them located in the heart of Riyadh.

The St Regis Riyadh and Six Senses Southern Dunes, The Red Sea have joined the list of best hotel openings from the last year, spanning the globe, from Argentina and Zimbabwe to Nepal and Spain, and more.

The St Regis Riyadh is “the only hotel inside Via Riyadh – a bijou mall of designer boutiques, hand-picked restaurants, and a cinema complex, wrapped within monumental sandstone walls at the edge of the Saudi capital’s Diplomatic Quarter – the St Regis Riyadh nods to the hotel brand’s New York heritage as well as its new Saudi home,” according to the publication.

Six Senses Southern Dunes, The Red Sea, is the first resort to open in the 28,000-square-kilometer expanse of sea, reefs, islands and inland desert known, simply, as The Red Sea. (Supplied)

Meanwhile, the new Six Senses Southern Dunes, The Red Sea, is the first resort to open in the 28,000-square-kilometer expanse of sea, reefs, islands and inland desert known, simply, as The Red Sea. It’s one of Saudi Arabia’s ambitious tourism-focused giga-projects, part of the Kingdom’s Vision 2030 aimed at diversifying the economy and heralding a new future for the nation.


Moroccan director Asmae El-Moudir joins Cannes’ Un Certain Regard jury

Updated 25 April 2024
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Moroccan director Asmae El-Moudir joins Cannes’ Un Certain Regard jury

DUBAI: The Cannes Film Festival announced on Thursday that Moroccan director, screenwriter and producer Asmae El-Moudir will be part of the Un Certain Regard jury at the 77th edition of the event, set to take place from May 14-25. 

She will be joined by French Senegalese screenwriter and director Maïmouna Doucouré, German Luxembourg actress Vicky Krieps and American film critic, director, and writer Todd McCarthy. 

Xavier Dolan will be the president of the Un Certain Regard jury. 

The team will oversee the awarding of prizes for the Un Certain Regard section, which highlights art and discovery films by emerging auteurs, from a selection of 18 works, including eight debut films.

El-Moudir is the director of the critically acclaimed film “The Mother of All Lies.”

The movie took the honors in the Un Certain Regard section, as well as winning the prestigious L’oeil d’Or prize for best documentary at the festival in 2023. The film explores El-Moudir’s personal journey, unraveling the mysteries of her family’s history against the backdrop of the 1981 bread riots in Casablanca.

El-Moudir is not the only Arab joining the Cannes team. 

Moroccan Belgian actress Lubna Azabal this week was appointed the president of the Short Film and La Cinef Jury of the festival. The La Cinef prizes are the festival’s selection dedicated to film schools.


Second Ritz-Carlton Reserve in Saudi Arabia planned for Neom 

Updated 25 April 2024
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Second Ritz-Carlton Reserve in Saudi Arabia planned for Neom 

DUBAI: Marriott International, Inc. announced on Thursday that it has signed an agreement with Neom to open its second Ritz-Carlton Reserve in Saudi Arabia. 

The hotel is anticipated to open in Trojena, a year-round mountain destination located in the northwest region of the country. 

The resort is expected to feature 60 expansive one-to-four-bedroom villas. Plans also include a range of amenities including a spa, swimming pools and multiple culinary venues.

Chadi Hauch, the regional vice president of Lodging Development Middle East, Marriott International said in a statement: “Together with Neom, we look forward to bringing this ultra-luxury experience to Trojena. This signing also marks an important addition to our portfolio in Saudi Arabia where we continue to see a strong demand for our luxury brands.” 

“Trojena is a rare destination, and we are delighted that Ritz-Carlton Reserve has hand-picked the mountains of Neom for their next property.  Together we will create an experience that can’t be recreated anywhere else. Our visitors and residents will experience a sanctuary that will capture the magic of Saudi Arabia, embracing ultimate luxury in an unforgettable location,” executive director and Trojena region head Philip Gullett said in a statement. 

Trojena, one of the flagship developments within Neom, is being developed and positioned as a year-round adventure sports destination that will include activities such as skiing, water sports, hiking and mountain biking. It will also include apartments, chalets, retail, dining, entertainment, leisure, sports and recreational facilities, and other hospitality offerings, including a W Hotel and a JW Marriott Hotel.

Ritz-Carlton Reserve currently boasts a  collection of only six properties in destinations including Thailand, Indonesia, Puerto Rico and Mexico.