Between 2010 and 2017, the number of prostate cancer centres at NHS hospitals offering robotic surgery has more than tripled – increasing from 1 in 5 (12 of 65) centres in 2010 to over three quarters (42 of 49) this year. This has been due to the centralisation of complex cancer surgery into fewer, high-volume units as well as the rise in the number of men attracted to centres offering robot-assisted radical prostatectomy.
Of the 16 centres that closed in that time, none offered robotic surgery. The rise of robotic surgery has occurred despite a lack of evidence of improved outcomes in terms of survival and side effects for the new technology compared to traditional open surgery. Experts writing in The Lancet Oncology journal this month said that, as a result, better regulation is needed to assess technology delivery in the NHS, and that quality indicators should be made available to inform patient choice.
“It appears that patients use the availability of robotic prostatectomy as an indicator of high quality care, despite a lack of evidence of its superiority compared with open surgery,” said Dr Ajay Aggarwal, lead author from the London School of Hygiene and Tropical Medicine. “NHS hospitals are subsequently investing millions of pounds into new and sometimes unproven technologies which has a direct impact on the type of care patients receive, but also the configuration of services as a whole.” Patients are certainly not being put off by putting their bodies in the hands of robots, albeit ones operated by experienced surgeons. A survey of over 2,000 adults, to coincide with London Tech Week earlier this year, found that 41 per cent would have a microchip installed in their body to monitor their health and 30 per cent would be happy to have surgery performed entirely by a robot. The key reason is precision. Robotic surgery’s main advantages are reduction in blood loss, shorter hospital stays and quicker recovery, surgeons say. And they are increasingly being used in many areas of medicine.
Builder Steve Bradbury, from Weir, revealed how he was spared major surgery and the need for radiotherapy and chemotherapy after having a cancerous tumour removed from his throat by a revolutionary surgical robot. The 66-year-old said he feels “highly privileged” to have become one of the first head and neck patients to undergo the operation using the robot at the Royal Blackburn Teaching Hospital . “The procedure only took 25 minutes and medics came over from Germany to see it done,” he told the Lancashire Telegraph. “I had the tumour and one of my tonsils removed by the robot and everything was a success.”
Days later, his surgeon said they wanted to “go back in” with the robot to remove some of the scar tissues – a situation they would have been unable to do with traditional treatment as with chemotherapy and radiotherapy, surrounding tissue is damaged. “The robot is absolutely marvellous as not only does it do the surgery, it stitches you back up as well,” Mr Bradbury said. “Without the robot, they would have had to split my bottom lip to my chin then cut into my jaw to open it up like a book and then split my tongue as the tumour was in such an awkward position.”
He was back at work carrying out physical tasks within weeks after his stay at the hospital, part of East Lancashire Hospitals NHS Trust, and the only one in the North West that is carrying out head and neck surgery robotically. St Bartholomew’s Hospital in London was this month rated “Good” overall by the Care Quality Commission – with the “well led” area of surgery, where it is at the forefront of new technology, given an “Outstanding” rating. The hospital is in the process of introducing a robotic surgical team with a fully adapted robotic surgery theatre. This will allow the surgery services to offer less invasive cardiothoracic (heart, lungs and other chest) surgery procedures, which led to faster recovery times, minimised trauma, and reduced pain – and mean Barts will have the only dedicated cardiothoracic robot in the UK.
“We have jettisoned the traditional way of minimally-invasive thoracic surgery as we have a much more precise surgery option with far better vision and dexterity, and we can do more redo and more complex operations this way,” Sasha Stamenkovic, consultant thoracic surgeon at the Barts Health NHS Trust, tells i. “Robotic surgery reduces pain, complications of pain, and there is evidence that there is a reduction in this resource/critical care readmission and possibly even death as a result. Robotic patients go home earlier with less or no complications and less or no pain. Ten per cent of my patients have no pain. One patient has gone home within 24 hours of their operation, five patients have gone home just over 24 hours later, but most patients go home by day two. Compare this to the week or so that a patient who has had an open operation stays. These patients sit side by side and the robot ones know they are doing better than the open ones.”
The only pitfall it seems is when a robotic arm gets stuck, but a key is provided to unlock it. There is also 24/7 engineering help available and constant monitoring of any robot operation in the world, so if there is an engineering problem, it is picked up within seconds. “Any surgeon can do harm to any patient, but with the best training and lots of simulation practice this is minimised,” Mr Stamenkovic says. “There is really extensive training in the machine, the workings of the arms, and the operations. It starts with a computer, then a live pig model, then a cadaveric model and finally first human operations happen under strict control of a proctor [mentor]. Nothing has ever gone wrong with the robot in my experience.” Many surgeons, like Mr Stamenkovic, now believe robotic surgery will soon be the default option for surgeons and patients alike. “We will never return to the previous way of operating,” he says. ” I predict that eventually all units in the UK will be using some form of a robotic platform because of the benefits it gives.”