Robot-assisted surgery
require to ensure they are competent and safe. A framework is being developed for training new starters, across all specialties. The robotic system manufacturer already provides online education and in-person training, but the Trust is also looking to increase in-person training around emergency situations – such as undocking the robot. She went on to highlight the Trust’s theatre utilisation with robotics. Comparing the figures for May 2025 with the same period in 2024, NNUH has completed 21 more cases. The average start time has improved by 9 minutes, and the overall utilisation has increased from 94% to 105%. “These figures put us in the top five for utilisation in Europe. We only have two systems, and we need more robots to give access to more specialties. There is a saying that it takes a village to raise a child, but it takes a team to deliver robotic surgery. Ultimately, achieving our milestone of 5,000 robotic procedures was down to teamwork. “Looking to the future, we have had our business case approved for two more robots, which is really exciting. We are going to enhance our training programmes, and we want to continue to collaborate globally to strengthen international partnerships and share the knowledge and our practices,” she commented. “Hopefully, successful implementation, will allow for the growth, development and improvement of our overall NHS,” she concluded
Development of an oesophagogastric robotic service Nicholas Penney, Consultant Oesophagogastric Surgeon and Robotics Specialist at NNUH, went on to provide an insight into the development of an Oesophagogastric Robotic Service at the Trust. One of Nicholas’ landmark achievements was performing the first fully robot-assisted, minimally invasive oesophagectomy at NNUH. His session explored the establishment of
the robotic surgery programme at NNUH, the challenges faced, the valuable insights gained along the way, as well as discussing a case study detailing the hospital’s first robotic-assisted oesophagectomy. Nicholas has recently been appointed as
the Training Programme Director for Robotic Surgery for the East of England, where he will play a vital role in mentoring and training the next generation of robotic surgeons. His expertise in advanced laparoscopic and robotic surgery includes oesophagogastric cancer treatment, gallbladder disease, hiatus hernia repair, anti-reflux surgery, and upper gastrointestinal endoscopy. Since joining NNUH as a Consultant Upper Gastrointestinal Surgeon in 2023, Nicholas has
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Mr Penney and team
requires large incisions and leads to prolonged recovery times. While other specialties have been performing
Mr Penney with the Da Vinci robot
been instrumental in expanding the hospital’s robotic surgical capabilities. After qualifying from Imperial College London, he undertook higher surgical training in Surrey and Sussex. He gained further expertise in oesophagogastric cancer resections at the Royal Surrey County Hospital and the Royal Victoria Infirmary in Newcastle upon Tyne, one of Europe’s largest oesophagogastric cancer centres. During his time in Newcastle, he completed a Fellowship in Robotic Surgery under Professor Immanuel. He gave an overview of oesophagectomy
throughout history and highlighted how far we have come. Historically, the mortality rate following oesophagectomy was very high and the quality of life post-surgery was often very poor – if the patient survived. Laparoscopic approaches were developed to provide minimally invasive surgery, but the procedure is still very technically demanding and there are few centres offering this even today – many centres continue to use open surgery, which
robotic surgery for some time, upper-GI has been slower to adopt robotics, largely due to complexity, and the pandemic further slowed progress to some degree, he explained. Today, adoption of robotics offers an opportunity to increase precision and improve outcomes for patients. Some key advantages include better vision inside the patient with 3D, improved camera stability, greater degrees of movement, motion scaling, better dexterity and precision, and elimination of the fulcrum effect (the perception of stiffness can be distorted in minimally invasive surgery). The robotic approach results in less pain, less scarring, reduced blood loss, improved functional outcome, reduced post-operative pneumonia, increased lymph node yield, reduced conversion to open surgery, and reduced operative time. The disadvantages include the higher cost, no tactile feedback and the surgeon is separated from the patient. It can also affect the team dynamic as the surgeon, anaesthetist and surgical team are quite separate in robotic surgery, compared to open or laparoscopic surgery. With the adoption of any new technology, safety is key, and this was a top priority for Nicholas when implementing the robotic approach. Training was thorough and the move to robotics was built up slowly, performing cases that were less complex initially.
Pioneering the first robotic- assisted oesophagectomy at NNUH The first robotic osesophageal procedure was conducted on 54-year-old Lee Moreton, a cancer patient from King’s Lynn, and took an extensive 14 hours to complete. During Alex’s earlier
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