Robotic Surgery in the Middle East is coming of age says Mansoor Ahmed, Executive Director – Middle East & Africa (MEA) Region at Colliers 

The Middle East healthcare sector is going through a rapid expansion and transformation. Increases in population, income levels, life expectancy, along with lifestyle-related and non communicable diseases (NCDs) have caused Middle East countries to be ranked among the top 20 countries in world for the highest level of obesity, hypertension and diabetics. Facing these challenges, regulators, providers, payers and patients, both in the public and private sector, are focusing on to improve the overall provision of the healthcare offering the region.

Many regional governments have initiated and implemented positive reforms which are pivotal to improve the overall quality of healthcare services in the region and have resulted in increased private sector participation. These reforms include PPP initiatives, mandatory health insurance and other initiatives to bridge the demand-supply gap.

Of late, especially after the pandemic, a lot of emphasis is being placed on bringing in and implementing new technologies. There is also increased focus on specialised care models, such as genome sequencing, stem cell therapies and clinical trials with focus on virtual health, artificial intelligence (AI), wearables, blockchain and precision medicine.

Beside these and many other initiatives, robotic surgery in the region is coming of age with many healthcare providers both public and private beginning to offer robotic surgery as an option to patients. The benefits of robotic surgeries include better visuals compared to traditional techniques by providing highly magnified and resolution vision of the operating field, resulting in physicians enhanced precision, higher flexibility and range of motion and dexterity, and more control during the procedures.

History of robotic surgeries 

For centuries, surgeons have operated using large incisions to gain a full view of the organ they need to operate on the patient. Recovery time for such taxing procedures is extensive and post-operative complications are a common occurrence.

The introduction of Minimally Invasive Surgery (MIS), also known as keyhole surgery or laparoscopy, has drastically improved patient outcomes. Using smaller incisions, the risk of infection can be reduced and recovery can be accelerated. Many studies have shown that MIS results in decreased post-operative hospital stays, quicker return to work, decreased pain and better immune function.

However, there are several drawbacks to MIS due to the technical and mechanical nature of the equipment. These limitations make MIS procedures more challenging, reduce their efficiency and increase operating time.

Computer-assisted surgery was developed to overcome the limitations of MIS and to expand its benefits. Classified as a type of MIS, it involves the use of robotic systems to execute surgical procedures. Although robotic surgery has technically been around for more than 30 years – the first documented robotic surgery was performed in 1985 – it has not been widely implemented in medical settings. However, in last 10 years or so, the robotic surgery market has expanded rapidly due to advancement in technology and increased acceptability across the globe. Based on various estimates, the global surgical robotic market was valued at between $7 billion to $8 billion in 2022 and is expected to reach $18 billion to US$ 20 billion by 2030.

Robotic surgery in the Middle East 

Presently, around one million robotic surgeries have been performed worldwide with 75 per cent of the procedures performed in the USA. Robotic surgery was first introduced in the Middle East in Kingdom of Saudi Arabia in 2003, followed by Qatar in 2010, and Kuwait and UAE in 2014.

There are close to 50 Da Vinci surgical systems installed in the region. Saudi Arabia has the highest number of installations with 19 Da Vinci surgical systems and 930 documented robotassisted procedures performed between 2004-2010. The Middle East witnessed an increase in robot-assisted surgeries by 60 per cent between 2011-2017.

In the UAE, the Ministry of Health and Prevention (MoHAP) is a pioneer in adopting and encouraging robotic surgery. In 2014, MOHAP announced the launch of the first robot for catheterisation and cardiac surgery through computerised systems in Al Qasimi hospital, Sharjah. Rashid Hospital in Dubai under the governance of Dubai Health Authority (DHA) also adopted robots in cardiac surgeries.

With the successful use of robots in heart surgery, MOHAP initiated the Gynaecology and Obstetrics Robotic Surgeries Programme in 2019. During that year, MOHAP performed 126 robotic surgeries in six clinical specialties. The robotic systems are installed across different facilities of MOHAP such as Al Qasimi hospital – Sharjah, Kuwait Hospital and Dubai.

Abu Dhabi Health Services Company (SEHA) also adopted robotic surgery in its Sheikh Shakhbout Medical City (SSMC) and performed its first robotic surgery in 2020. Dubai Hospital has launched the Da Vinci Xi Surgical Robot for performing robotic assisted minimally invasive surgeries in 2022.

With robotic surgery becoming the new standard of care globally, the private sector in UAE is catching up with the trend to provide this cutting-edge technology to the UAE population. The focus is on the treatment of gastrointestinal surgeries, thoracic surgeries, gynaecologic surgeries and heart surgeries, with a focus on prostate cancer, digestive diseases, urological procedures, hysterectomy and mitral valve in the UAE.

In Dubai, robotic surgery was introduced in the private sector by American Hospital in 2020. Currently Mediclinic Hospital, Saudi German, Al Zahra and Clemenceau hospitals have robotic surgery platforms to cater to patients across different specialties. Cleveland Clinic performed its first robotic surgery in Abu Dhabi in 2015 through its Da Vinci system, while Burjeel Hospital has launched E-GPS Robot for spine surgeries.

Overall benefits of robotic surgery 

Robotic surgery in the region is expected to grow exponentially in the coming years, with the UAE and the KSA to take the lead. Robotic surgery has great advantages over traditional and laparoscopic surgical methods by offering greater precision, reduced bleeding, smaller incisions leading to smaller scars, reduced hospital stay and less chances of hospital acquired infection.

With healthcare moving towards value-based care and implementation of mechanisms such as Diagnosis Related Groups (DRGs), the cost of complications and longer hospital stays must be absorbed by the hospital and not the insurer. With the advantages offered by robotic surgery, in terms of better clinical outcome and reduced hospital stay, the hospitals will benefit from reduced patient care costs. Moreover, the growth of robotic surgeries increases ROI as a result of better medical outcomes and increased bed turnover, superior efficiency and lower costs, providing a competitive edge compared to competitors that can attract medical tourists and capture medical tourism outflows from the region.