Robotic Surgery Saves A Kidney Or Uterus, Hospital Picaso Urologist Tells Insurers

A Hospital Picaso urologist says robotic surgery, which costs extra RM15,000, can avoid loss of a kidney or uterus from non-assisted surgery for cancer patients. “Insurance companies don’t have the last call; it’s medical evidence that has the last call.”

 

Dr Loh Chit Sin, consultant urologist at Hospital Picaso, speaks at a media briefing at Hospital Picaso in Petaling Jaya, Selangor, on February 28, 2025. Photo by Boo Su-Lyn.

 

PETALING JAYA, March 19 — A urologist at Hospital Picaso has justified the cost of robotic surgery, a 20-year-old technique that is now a gold standard procedure in Western countries.

Dr Loh Chit Sin, a consultant urologist at the private hospital here, said the use of robotic surgery adds another RM10,000 to RM15,000 to a patient’s bill, but stressed the value of the technology beyond monetary cost.

“If the use of the robot stands to save you from losing a kidney, that will be very much worthwhile, or a woman preserving her uterus instead of losing it and therefore her fertility and all that. These are things that you cannot put money on,” Dr Loh told a media briefing at Hospital Picaso last February 28.

“There’s no question that if you allow a surgeon who does keyhole surgery to choose between with or without the robots, almost everyone will say, ‘I would like to use the robot’, which is just a lot better, easier, and a lot more civilised. 

“But more importantly is the fact that it allows you to do things that would otherwise be impossible to do. That is not easy to put dollars and cents on. So if you take out a prostate and make a person leak urine for the rest of his life versus RM15,000 extra where he gets to play sports without leaking at all, well, you cannot cost that.”

He explained that in the past, kidney cancers were treated by total nephrectomy, where the whole kidney is removed. But robotic surgery eliminates the need for kidney removal.  

“So robotic surgery has this enabling effect – making what was impossible now possible – and it’s a work in progress.” 

Hospital Picaso medical director Dr Luqman Mazlan, who is also a consultant general and colorectal surgeon, noted that robotic surgery on the deep pelvis is able to save the anal sphincter with a really low down tumour.

“The patient will not have a permanent stoma. That makes a lot of difference,” he said.

Dr Loh, who is president of the Malaysian Urological Association, stressed that robotic surgery is used “judiciously” and that the extremely precise surgical technology isn’t used for appendectomy, for example. 

Robotic surgery is now the “gold standard” in the West for prostate, kidney, and bladder cancer, besides growing in use for gynaecological and upper gastrointestinal cancers. 

“Despite the high cost, they are selling, which means people are paying for it. There must be a reason behind it. And the reason is it does offer surgeons very unique advantages and benefits the patients,” Dr Loh said.

“What this will do most of the time is to make surgery better for the patient – less pain, less bleeding, faster recovery, and better function. In some situations, it will improve the choice that they face – the choice of having to wear a [colostomy] bag versus no bag, the choice of having two kidneys rather than one, or the choice of keeping your uterus or not.” 

Hospital Picaso currently operates two Da Vinci Xi Surgical Systems, each capable of handling 300 to 450 cases per year, reflecting the growing demand for robotic-assisted procedures.

According to Dr Loh, robotic surgery was developed through funding by the United States armed forces to avoid losing surgeons in the battlefield. The technology was then sold to a company and developed over the last 20 years to manage limitations with handheld keyhole surgery.

While minimally invasive surgery has grown in the past two to three decades – in which complex surgery is conducted through a few small holes in the patient’s body – the instruments have restricted movements and are difficult to control with a human hand.

“With robotics, it really makes a big difference because we have stability and dexterity. We are able to do very complex movements inside the tummy without our hands being inside. For example, you can turn your instruments as if your wrist is inside the body,” Dr Loh said.

“In laparoscopic surgery, we put in a long instrument. The system will pull the camera; we’ll move the instrument with our own hand and we do the surgery. But there are a lot of limitations with laparoscopic surgery because the instrument is a rigid instrument that cannot angulate.

“With robotic surgery, the robot holds the instrument and puts it into our body through the hole, but we are the surgeon controlling the arm of the robot, performing surgery inside. Every movement follows our wrist and fingers. The robot will never move on its own.”

Dr Loh highlighted a case a year ago where a surgeon in Rome, Italy, carried out an operation on his patient in Beijing, China, through robotic surgery. He also cited a video of a robot’s ability to write a Chinese character on a grain of rice that shows the accuracy and precision of the technology. “Robots have an indispensable role,” he said.

Robotic surgery technology costs about US$2 million (RM8.9 million) to US$3 million (RM13.2 million) internationally. Dr Loh acknowledged that while companies will want to get their investment back, he expects prices to reduce due to competition and lower surgical costs. 

The urologist also said he conducted three kidney surgeries recently, including two without robots because his patients’ insurance refused to cover robotic surgery.

“In a lot of situations, the outcomes have no difference. But there are certain situations where I would explain to them and say, ‘You’d better find this money because I can tell you, the outcome will be different.’ Many of them will do so. It is important to give patients a choice, rather than just, ‘no, I’m going to cut you open.’”

Dr Loh said doctors usually provide insurers full medical reports and published literature justifying the use of robotic surgery for their patients. However, insurance companies sometimes deny coverage of the surgical technology.

“The thing is, in a lot of insurance companies, the people there are not very well trained. Many of them actually don’t have a medical background and they work based on SOP (standard operating procedure). The first thing they do is to reject because they are told to reject.”

He added that hospitals usually continue supporting their patients despite denials of insurance coverage for robotic surgery. 

“Because there is literature, you cannot change what has been published black and white. So I think the message you want to get out there is that insurance companies do not have the last call,” said Dr Loh.

“It is medical evidence that has the last call. If the evidence is there, the doctors will say that and put it in the report. Patients always have the right to go up to as far as Bank Negara if they think that they are sort of shortchanged. That’s very important. 

“Unfortunately, in our society, we don’t understand these concepts of rights – consumer rights, patient rights. I think it’s time that this information needs to be sent across.”

 

Hospital Picaso-Device Technologies Collaboration To Upskill Surgeons With Robotic Surgery

Left to right: Dr Luqman Mazlan (medical director, consultant general & colorectal surgeon, Hospital Picaso); Ahmad Lutfi Abdul Rahman (general manager, Hospital Picaso); Joe Yew (country manager of Malaysia, Device Technologies) and Dr Loh Chit Sin (consultant urologist, Hospital Picaso) formalise the signing of a memorandum of understanding (MOU) between Hospital Picaso and Device Technologies at Hospital Picaso in Petaling Jaya, Selangor, on February 28, 2025. Photo courtesy of Hospital Picaso.

 

Hospital Picaso and Device Technologies, a medical technology supplier based in Australia, have signed a memorandum of understanding (MOU) to drive the adoption of robotic-assisted surgery and upskill the next generation of surgeons in Malaysia.

The MOU will establish a dedicated training hub to equip surgeons with hands-on expertise in robotic-assisted procedures. As part of the programme, surgeons will undergo structured training and proctorship, learning to operate the robotic system before performing procedures under the supervision of experienced surgeons. 

Once certified, they will be able to perform robotic-assisted surgeries independently. The training hub will also cater to international surgeons, reinforcing Malaysia’s role as a regional centre for robotic surgery. 

“Malaysia has seen one of the fastest-growing adoption rates of robotic-assisted surgery in Southeast Asia,” Dr Luqman told the media briefing.

“With the right training and expertise, we can make robotic-assisted surgery a standard of care in Malaysia.”

At the heart of this collaboration is the Da Vinci Xi Surgical System, a fourth-generation robotic-assisted platform that redefines precision surgery. It offers high precision and control, enables minimally invasive procedures that reduce scarring, pain and recovery time, and lower surgical risks, such as blood loss and infection.

Through this partnership, Device Technologies will offer world class training and support for surgeons, facilitate the expansion of robotic surgery adoption in the region, and strengthen Malaysia’s position as a hub for medical innovation and health tourism.

“The essential part of robotic surgery is the training and education of surgeons. By partnering with Hospital Picaso as a training centre, we aim to develop and support the next generation of robotic surgeons, ensuring the best outcomes for patients,” said Device Technologies Malaysia country manager Joe Yew.

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