Innovation
Advancing prostate cancer surgery
The Stokes Centre of Urology team at the Royal Surrey NHS Foundation Trust is breaking records and breaking new ground in prostate cancer surgery. Wissam Abou-Chedid, a Consultant Surgeon at the Trust, and a Prostate Cancer UK Clinical Champion, speaks to CSJ about the potential impact these advances could have if adopted across the UK.
Prostate cancer is the most commonly diagnosed cancer in men in the UK. Globally, more than 1.4 million men are diagnosed with prostate cancer each year. Surgical removal of the prostate, or radical prostatectomy, remains one of the gold standard treatments of choice for men with clinically significant localised prostate cancer. Increasingly, the procedure is performed using minimally invasive approaches using robotic technology such as the Da Vinci. The approach helps to reduce blood loss during surgery, minimises side effects and shortens the length of hospital stay for patients. The Royal Surrey NHS Foundation Trust is
one of the top three hospitals in the country performing surgical procedures using minimally invasive robotic procedures and boasts a world record for the most robot-assisted radical prostatectomies (RARP) performed in a single day. Surgeons at the Trust have been performing robot-assisted procedures for more than a decade and, in February of this year, the urology
team reported that they had completed their 4,000th robotic-assisted procedure. Across the whole Trust, the number of operations using robot technology reached 7,500. In addition to achieving these impressive
milestones, the Trust has pioneered some innovative approaches that are maximising efficiency, reducing waiting lists, improving patient outcomes, increasing patient satisfaction, and improving sustainability. Consultant surgeon, Mr Abou-Chedid, has
helped to drive forward these important initiatives – they are now transforming prostate cancer care for men and have the potential to make a significant difference if rolled out across other UK Trusts.
Day case RARP It is important for robot-assisted surgery to be cost-effective, especially by reducing the length of stay (LOS). Therefore, the team at the Royal Surrey NHS Foundation Trust developed a
protocol for day case RARP. Patients previously spent at least one night in hospital after undergoing the procedure. This was still a short time compared to the week- long recovery expected through traditional surgical techniques. However, by implementing day case RARP, patients are now able to go home on the same day if they feel well enough. “Using the robots means that patients are
days ahead in their recovery compared to people who have had full open surgery because they do not have the trauma of a large incision in their abdomen and their organs moved about. We know from research that patients recover far quicker in familiar surroundings,” commented Mr Abou-Chedid. A study was carried out to validate this
approach as safe and to assess the potential benefits to the hospital and patient. All patients booked for RARP between April 2022 and October 2022 were screened for suitability for day case, and all tumour types were included. Exclusion criteria included: a history of complex abdominal surgeries, salvage prostatectomy, body mass index (BMI) > 35 and patient living alone or > 150 km away from the hospital. All day case RARPs were performed as a morning case with a protocol for review throughout the day with evening discharge if mobilising independently and eating/drinking well. The study looked at the success rate of discharge home on day of surgery (DOS), as well as the outcomes such as readmissions and complications. A patient questionnaire was completed at home – including both visual analogue scale (VAS) for pain and satisfaction rating. Forty-five patients underwent day case RARP
Mr Abou-Chedid (bottom left) and colleagues at the Stokes Centre for Urology celebrated the completion of their 4,000th robotic-assisted procedure in February this year.
over a six-month period with a minimum of 30 days of follow-up. 41/45 (91%) had successful DOS discharge home. The four admissions overnight were due to dizziness, low oxygen saturation, intraoperative complications and a
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