Malaysia is continuing technology adoption across multiple sectors. Recent examples include smart healthcare initiatives — such as robotic surgery and other advanced health tech in the private sector. These are being galvanised by digital’s ability to slash time and distance – a factor that certainly helped address critical gaps during the lockdowns.
According to McKinsey, the size of the global digital health market is expected to rise to US$515 billion by 2024 from US$350 in 2019. COVID lockdowns demonstrated multiple benefits from digital technologies– for example, the use of health tracking apps, management of immunisation programmes and maintaining the expansion of healthcare delivery into rural areas.
Interestingly, several countries are maintaining COVID tracking apps. To some extent, these are travelling the same road as the UK’s NHS app. Examples include Malaysia’s mySejahtera app, now morphing into a broader health platform, while India is considering pivoting CoWin into a universal immunisation and blood donation app.
To dive deeper into healthcare robotics, Disruptive.Asia recently talked with a noted pioneer of robotic surgery in Malaysia, Dr Thangesweran Ayakannu, who said that robotic surgery was already available in two hospitals in the country and should expand in 2023.
Returning from the UK, where he most recently served, and introduced a robotic surgery programme and service in Gynaecology, Gynaecology Oncology, and Urogynaecology at one of the largest standalone women’s hospitals in Europe, the Liverpool Women’s NHS Trust. There he performed its first robotic total hysterectomy and bilateral salpingo-oophorectomy.
Today, Dr Thankesweran continues to advocate robotic surgery under his portfolio as a Consultant Gynaecology Oncology and Robotic Surgeon at Sunway Medical Centre in Kuala Lumpur, Malaysia.
“I promised my father that I would come back to help women in Malaysia, who may suffer from gynaecological and gynaecological oncological conditions, with the best and latest technologies to provide a safe and elegant surgery,” he said.
In addition, his aim of developing Sunway Medical Centre as a robotic centre of excellence for gynaecology and gynaecology oncology is part of a mission to take robotic surgery in this field of gynaecology to the next level, both nationally and internationally.
“We would like to offer this robotic surgery as an easily available service to all women and hope that the insurance bodies in Malaysia help to champion this procedure and pay the full cost of the robotic surgery under the umbrella of minimal access surgery,” he said, adding that he envisions the centre of excellence for robotic surgery in gynaecology and gynaecology oncology to also act as a training centre and focal point national and international conferences.
Speaking to the adoption of technology in his field, Dr Thangesweran cites an 1885 quote from Dr Freidrich Trendelenburg: “…There are numerous technologies outside the immediate interest or view of surgeons, which will either require surgeons to implement or which will impact upon the way surgery is performed or possibly even replaced….”
Robotic surgery is safe, elegant
He explained, “Robotic surgery is an excellent surgical platform, especially to deal with the gynaecological and gynaecological oncological backlog due to the COVID pandemic. A robotic surgery system can be used for a safe and elegant surgical outcome with a quick turnover.”
Recognition of the minimally invasive surgical technique includes the UK’s Royal College of Obstetricians & Gynaecologists (RCOG), the American College of Obstetricians and Gynaecologists (ACOG), and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZOG).
In common with findings from ACOG, and RANZOG, a recent RCOG review found that ‘another clear advantage of robotic surgery is that fewer errors are made than with straight-stick surgery’ and a review of ‘hysterectomies comparing operations conducted by robotic surgery and laparoscopic surgery showed that robotic surgery was quicker, reduced the hospital stay of the patient and resulted in less blood loss’.
Dr Thangesweran said this was borne out by comments, which confirmed rapid recovery and reduced discomfort as well as a sense of mental wellbeing, from Malaysian patients under his care.
Advancing Malaysia’s smart healthcare industry
Dr Thangesweran also outlined the use of robotics in recent years, using the illustrations below.
Speaking to the challenges of pioneering this technique, he said, “The main challenge in starting a robotic program in the middle of COVID pandemic in UK was the cost of the programme.”
“However, on closer examination —when you consider the long-term benefits of various disciplines coming together to provide this service has proven to be very effective,” Dr Thangesweran points out. “I believe the cost of the service remains the immediate challenge all over the world; however, I believe with the various disciplines —gynaecology, gynaecology oncology, colorectal, hepatobiliary – coming together in collaboration to provide robotic surgery has proven efficient on many levels including cutting costs and enhancing efficiency and heightened patient care.”
Malaysia can take a lead with advanced healthcare, he said. “In my view, the Ministry of Health and insurance bodies would ideally need to recognise the Da Vinci robotic surgery care service for women as an ideal approach to manage their complex gynaecological and gynaecological oncological conditions.”
“We should encourage the government sectors and private sectors to collaborate as a team and further invest in advanced robotic surgery initiatives. In addition, Malaysia has the opportunity to pioneer a national training programme for the future generation of doctors.”
He recommends a refreshed review of robotic surgery to counter the mindset that it is too costly. “I believe we need to educate the users and the insurance providers to compare traditional procedural costs, medications and length of stay– and realise that adopting robotic surgery is far more cost-effective. And even more important, the patient recovers faster, can go back to work, and continue contributing to the economy.”
Admitting that there was always human resistance to change and new technologies, he stressed that the robotic surgical system is developed with the safety and comfort of the patient as paramount objectives. “The Da Vinci system has been developed with multiple safety mechanisms to avoid any software failures, for example, and the human is always in charge.”
Smart healthcare ecosystems
On global and national levels, robotics is part of a broad tide of positive disruption in healthcare.
In The next wave of healthcare innovation: The evolution of ecosystems study, McKinsey opined that forthcoming healthcare ecosystems would need to adapt to the needs of different patient populations and their relevant, effective care journeys.
“The consumer-oriented nature of these ecosystems also will increase the number of healthcare touchpoints, with the goal of modifying patient behaviour and improving outcomes.”
In Asia, many stakeholders have or are preparing to support health ecosystems: joining insurers, providers, governments, new players, technology giants, banks, telcos and industrial and retail conglomerates, among others.
Malaysia’s various governments tend to continue to encourage digitalisation as an important economic and transformational engine.
Last year, Malaysia’s national 4IR policy announcement included a ‘National Robotics Roadmap (NRR) to encourage mainstream adoption of robotics to the tune of increasing the country’s robot density of 55 units for every 10,000 workers in 2019 to 195 robots for every 10,000 workers by 2030. This was intended to boost productivity and reduce dependency on foreign labour and currency outflow.
Malaysia also envisioned a Centre for the Fourth Industrial Revolution (WEF-C4IR), affiliated with the World Economic Forum (WEF), in support of the national 4IR Policy. It is also the first in Southeast Asia, is part of a global network of 15 centres, and is aligned to the Malaysia Digital Economy blueprint, according to the MyDIGITAL corporation.
As part of its thrust on enabling Digital Malaysia and human-oriented digital transformation, TM One, the enterprise and public sector solutions arm of Telekom Malaysia, is accelerating smart healthcare adoption as part of its industry-wide portfolio of offerings.
Although the new government is reportedly reviewing certain aspects of Malaysia’s 5G adoption plans, the rollout is expected to move forward and will open up new levels of productivity and social gains.
Empowering healthcare with 5G
During its recent flagship event LEAP Summit 2022, Shazurawati Abd Karim, executive vice president of TM One, pointed to data as the core of a digital economy and that 5G will enable faster throughput in real time right to the computing edge. This will result in real-time detection and the potential for instant analysis and action. Other benefits include enhanced safety, reduced down-times, and the ability to scale up at speed.
To accelerate 5G adoption by enterprise and public sectors, TM One officially launched TM One 5G Sphere programme during the LEAP summit. This programme comprises TM One’s circle of industry ecosystem partners, smart solution and technology partners (currently with 37 partners) and is focused on generating an ecosystem to support the next phase of enterprise innovation and transformation by leveraging 5G.
Shazurawati explained, “The next phase of smart innovative transformation will be 5G-driven opportunities, with capabilities such as video monitoring, logistics, fleet management, and private 5G networks powering manufacturing, transport, factories, and campuses already on the horizon.”
The benefits of real-time data for healthcare include connected ambulances, remote medical consultations, conducting robot-assisted telesurgery with greater precision, flexibility and control, remote patient monitoring, and AR/VR medical training, among others.
One example of a collaborative initiative with industry was at the 5G in Healthcare Symposium earlier this year. Organised by the Association of Private Hospitals Malaysia (APHM), TM One showcased some of these possibilities – including a HoloLens demonstration, which utilises mixed reality experiences with 3D data processing, analytics, visualisation and simulation applications.
“TM One has already conducted and demonstrated many successful 5G service and use case trials,” said Shazurawati at the time. “Currently, we are rolling out further key 5G projects for various enterprises. Together with our extensive ecosystem of partnerships, which includes global technology companies as well as leading local companies, we are primed and ready to embrace the highly effective path of co-creation of solutions and services with Malaysia’s private hospitals.”
Moving back even further, in an interview at the beginning of this year, Shazurawati amplified the human aspects of digitalisation as the core of effective digitalisation to deliver benefits to people and the country.
“Moving forward, optimal 5G business solutions will arise from smart collaborations and coalitions among industry leaders, accelerating the next phase of technology adoption by both industry and the country as a whole and enabling our aspirations for a Digital Malaysia.”