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On October 17, 2022, the first challenging radical treatment surgery of thyroid cancer assisted by Toumai® was completed in The South China Hospital affiliated to Shenzhen University (“South China Hospital”) by the team led by Professor Shijian Yi, the Vice President of South China Hospital and Executive Director of Thyroid and Breast Department. Since there was almost no bleeding during the surgery, and no complications occurred, the patient recovered very quickly and was discharged in the morning of October 24, which demonstrated the excellent performance of Toumai® in the minimally invasive surgery.

As the patient suffers from basic diabetes mellitus and several other complications, the surgical and anesthetic risk factors are rather high, and serious complications might happen including peripheral thyroid organs injury, laryngeal edema and spasm. However, thanks to the accurate and flexible arms and the high-resolution 3D vision of the Toumai®, Professor Shijian Yi was able to operate stably, and accurately completed location, peeling and suturing. After two and a half hours, the surgery was completed successfully, and maximally reduced the risk of complications. The stability, safety and effectiveness of Toumai® enabled its perfect collaboration with the scientific and elaborate surgery scheme made by Professor Shijian Yi. This success has demonstrated the great potential of Chinese-developed surgical robots in clinical application exploration and solving highly challenging surgeries, and also marked a new milestone of Chinese-developed surgical robots in the clinical application.

Mr. Gu (pseudonym), the patient of this surgery is 40 years old. During the treatment for type 2 diabetes, the doctor found solid nodules at the right thyroid lobe, which was diagnosed as papillary thyroid carcinoma through needle aspiration and doctors consultation of the Department of Thyroid and Breast.

The preoperative preparation and disease evaluation showed that Mr. Gu suffers from diabetes and several other complications, so the surgical and anesthetic risk factors are rather high. And he is overweighted with a weight of nearly 100 kilos, which makes the situation worse. According to Professor Shijian Yi, there are many important organs around the thyroid such as parathyroid gland, recurrent laryngeal nerve, trachea, esophagus, artery and vein at the neck. Any damage to any organ may leads to serious complication. In addition, the patient is a heavy smoker, suffers from sleep apnea syndrome, and the airway is not good. Based on these factors, it is highly likely that serious complications like laryngeal edema and spasm might happen during the operation.

To ensure optimal recovery, reduce occurrence rate of complications and the risk of surgery, the surgery team led by Professor Shijian Yi organized MDT work meeting, had in-depth discussion on the disease of the patient, and continuously improved the surgery scheme and emergency plan.

Through team discussion, it was determined that Toumai® highly matches with the surgery scheme and is able to meet the requirements on positioning, removal of lesions and minimal damage to the peripheral tissue during surgery. In addition, prior to this operation, Professor Shijian Yi and his team have received professional training on Toumai® system, and have successfully completed several simulation surgeries on animals with the Toumai^® Laparoscopic Surgery Robot. In a word, they have mastered the operation of Toumai® and may proficiently collaborate with the robot during the surgery.

Finally, their trust for Toumai® is justified. After the surgery is successfully completed, Mr. Gu said: “It is out of my expectation that my surgery may be completed by a robot, and a Chinese developed robot!”

The success of this surgery has significant meaning in the clinical research field of radical treatment of thyroid cancer with domestic surgical robots. It is not only the first remarkable breakthrough of completing highly complicated and challenging surgery with the technology independently by our country, but also represents a step forward for the independent innovation and breaking the monopoly by foreign technologies on high-end medical devices.

An efficient and accurate collaboration between Toumai® and the operator is demonstrated during the whole process of surgery. After the surgery started, Professor Shijian Yi sat in front of the surgeon console, and observed the high-resolution 3D images amplified by Toumai®; several meters away from the doctor, Toumai® four mechanical arms operated accurately and flexibly under the control of Professor Shijian Yi. Rotate, clasp, pick, spin … the robotic arms hold a tweezer in the left and a forceps in the right, and complete seeking, peeling and suturing accurately and neatly in a narrow anatomy space. During the whole surgery process of around two and a half hours, there was almost no bleeding.

“Any mis-operation or error in the thyroid surgery is likely to damage the recurrent laryngeal nerve and the parathyroid gland. The surgical robot is able to provide us with a stable and high-resolution 3D vision. Even the minor blood vessel and nerves are visible. So we can accurately identify the recurrent laryngeal nerve and the parathyroid gland.” After the operation, Professor Shijian Yi said: “The instruments are mounted with human-like wrist joints, and is able to operate flexibly within the narrow cavity that cannot be reached by human hands. This may help us thoroughly remove the lesion, maximally reduce surgical damage and provide better protection for the nerves and blood vessel around the thyroid.”

The papillary thyroid carcinoma is the most common type of thyroid cancers among adults, especially among the population group of 20-40 years old. And the incidence rate among females is obviously higher than that among males. Since the thyroid is at the front side of the neck, a visible scar would be created in an open surgery, which brings life-long trouble for the patients. The surgical robot system operates via the chest/breast approach. So no scar will be left at the neck of the patient.

The success of this surgery is built on the superb surgical skills of Professor Shijian Yi’s team and their elaborate surgery scheme. And the Toumai® with its high-resolution 3D image and the stability of the highly flexible mechanical instruments also plays an indispensable role. The movement pattern of Toumai® four mechanical arms keeps consistent with that of human eyes and hands, and enables the operator to feel like he is operating an open surgery. This helps the surgeon applies its operation experience into the robotic surgery, performs the reverse joint operation that is impossible for normal wrists, thus helping the surgeon to perform more delicate and minimally invasive surgical operations.

Since the first clinical scientific research verification center of Toumai^® Laparoscopic Surgery Robot in South China was launched in the end of March this year, the South China Hospital has continuously carried out in-depth cooperation with MicroPort^® MedBot^® to accelerate the conversion of mature surgical robotic technologies in the field of clinical applications. The successful completion of surgery for radical treatment of thyroid cancer assisted by Toumai® by the Professor Shijian Yi team represents that the thyroid surgery assisted by surgical robots of the South China Hospital has reached leading level in China, and is a milestone in the long-term cooperation between the South China Hospital and the MicroPort^® MedBot^®.

Compared with imported devices, the Chinese self-developed robot-assisted surgery system enjoy an obvious advantage in the cost, reduce the medical economic burden for both patients and government. In the respect of operators, the robotic surgery features a more flexible operation, clearer vision, smarter assistance and shorten the  learning cycle in comparison with the traditional surgery. A number of hospitals across the country including the South China Hospital has set it as a key direction to develop pilot program of robotic surgeries.

According to Song Wu, the President of the South China Hospital, currently, many departments in the South China Hospital has begun to perform clinical investigational surgeries with the domestic surgical robots including the Department of Thyroid and Breast, the Urinary Surgery Department, the Gynecology Department, and the Cardiothoracic Surgery Department. This has provided more possibilities for the hospital to provide standard, accurate and personal diagnosis and treatment, and also helps with the accumulation of clinical proof and technical experiences, which will accelerate the development of robotic surgery in our country. It is believed that our experience achieved will bring benefits to more patients in the near future. More and more patients including the primary hospitals and the patients in remote areas will be able to enjoy the advantages of robotic surgeries and obtain even better post-operation life quality.

Mr. Yu Liu, Executive Vice President and Chief Commercial Officer of MicroPort^® MedBot^®, said: “The successful application of Toumai® in the thyroid cancer surgery and the breakthroughs made by the team of Professor Shijian Yi in the South China Hospital has not only demonstrated their extensive clinical experience and sophisticated surgery capability, but also verified the safety and effectiveness of robotic surgeries in various departments. We will continue to strengthen cooperation with the clinical experts, further innovate and update our products, and provide the doctors and patients with superb robotic intelligent surgical total solutions to ‘Make Surgery Easier, Safer and Less Invasive’.”