Kim Seon-hahn

Professor in Department of Surgery, Korea University College of Medicine

Kim Seon-hahn is one of the top robotic surgeons in the fields of colon and rectal cancer in Korea. He performed surgery on more than 500 cancer patients using the “single-docking full robotic low anterior resection,” a technique he developed. His reputation has brought him to some of the world’s best medical institutions, including the Cleveland Clinic and the Mayo Clinic, where he presented his techniques to other doctors.

Over the past 30 years, laparoscopic surgery – a surgical technique performed by making only a few tiny incisions – has changed both doctors’ and patients’ conventional ideas of surgery. Now, robotic surgery is revolutionizing the concept of minimally invasive surgery. “The efficacy of robotic surgery used to be doubted, but an increasing amount of data show that it is more effective and safer than laparoscopic surgery, which is the previous generation of machine-assisted surgery,” Kim Seon-hahn, a surgeon who specializes in colon and rectal cancer at Korea University Anam Hospital, said in an interview. “It is hard to predict how far robots will go from here, but less cutting and more automation will certainly be the future of surgery.” According to his study on 732 patients with rectal cancer at stages 1-3, those who received robotic surgery showed a higher five-year survival rate (91.3 percent) than those who received laparoscopic surgery (83.8 percent). The surgery using a laparoscope, a thin tube carrying a small camera, previously emerged as an alternative to open surgery, which requires large incisions. However, the da Vinci Surgical System, which was developed by U.S.-based Intuitive Surgical, is making inroads into a growing number of medical fields as the most advanced surgical machine. “The robot enables me to perform necessary procedures in the areas that I would not have been able to reach with rigid laparoscopic sticks, let alone entire hands, while getting a 3-D view of what’s happening inside the body,” Kim said. “It allows me to repair problems inside the patient’s body with far less damage and with far better precision.
Less damage means less chance of postoperative organ failure and faster recovery for patients.” The machine is not ideal for all types of surgery, but the total number of robotic surgeries performed has rapidly increased over the past decade. According to the Ministry of Health and Welfare, the number spiked to 8,840 cases in 2014 from only 17 in 2005, when the device was introduced to Korea. “Even the most skilled doctor with the steadiest hands cannot beat the robot. The number is only expected to continue to increase,” Kim said. Robotic surgery is common in the fields that require utmost delicacy, such as urology. Today, about 70 percent of prostate cancer surgeries in Korea is done with the aid of the machine. Kim is one of the top robotic surgery experts in the fields of colon and rectal cancer in Korea, and his reputation goes far beyond the country.
He performed surgery on more than 500 patients using the “single-docking full robotic low anterior resection” technique, which he also developed. His reputation has brought him to some of the world’s finest medical institutions, including the Cleveland Clinic and Mayo Clinic, where he presented his techniques to other doctors. He also teaches a regular training course for doctors at National University Hospital in Singapore starting in 2008 as a visiting professor. Kim believes the technological advancement will increasingly reshape surgeons’ roles in operating rooms, urging them to adapt to the new era of medicine. “Some surgeons are concerned that robots will limit their roles, but I see it differently,” he said. “I believe robots will enlarge the capabilities of surgeons by enabling them to do more on their job, with better visualization, enhanced dexterity and more stability. The surgeons’ main role is expected to change to that of a controller and supervisor, but their overall influence will strengthen.” All these technological advancement makes training important for surgeons. “That’s why I have focused more on teaching my students over the past few years,” Kim said. “After all, if robots are good for patients, they have to be utilized. At this point, we all should ask ourselves how to better use technologies to benefit more patients rather than whether to use them.”

From hands to laparoscopes to robots

Kim has always been at the forefront of using new surgical technologies, even early in his career. In 1995, when few surgeons understood the concept of minimally invasive surgery in Korea, he had the opportunity to study the field at the Cleveland Clinic in Ohio. “I was fortunate to learn under the guidance of great teachers, including Jeffrey Milsom, who contributed greatly to establishing the concept of minimally invasive surgery in the United States,” Kim said. “The concept was about changing a paradigm of medical services, from the convenient way for surgeons to the more beneficial way for patients. I thought it would be the future of surgery for sure.” He returned to Korea in 1997. “I was excited and ready to spread the concept, which was still new to the country,” he said. But unfortunately, the Korea University Medical Center and patients were not ready for change yet. “Few people knew what it was, and there weren’t enough facilities for laparoscopic surgery in the hospital,” he said. “For years, only a few patients took advantage of it.” He decided to leave for Seoul’s Hansol Hospital, which offered him an opportunity to use his laparoscopic surgery skills. For about four years, Kim performed surgery on 500 patients with colon or rectal cancer there, building his reputation as one of the country’s top experts in laparoscopic surgery. But Kim eventually returned to Korea University Anam Hospital because he wanted to train junior doctors. He has performed surgery on additional 1,500 patients at the hospital since then, while teaching medical students. Meanwhile, the concept of minimally invasive surgery has since become known to many doctors and patients in the country. Today, laparoscopic surgery accounts for 65 percent of all surgeries for colon or rectal cancer patients, among the highest levels in the world. “It’s not just numbers. The five-year survival rate of stage 2 colon cancer patients who received surgery is more than 90 percent, which is about 10 percent higher than the average level at U.S. hospitals,” Kim said. Kim also mastered and taught the da Vinci Surgical System, which was approved by the U.S. Food and Drug Administration in 2000 and adopted by Korea University Anam Hospital in 2007. “Some surgeons ask me why we should use robots when we still can do our job without them,” Kim said. “I was a good surgeon before the emergence of laparoscopic instruments or robots, but from my experience, I came to know the limits of my bare hands. Surgeons need to embrace good technologies as good partners, and for our patients and ourselves, we should keep learning.”