Robot-assisted surgery
presentation, delegates had the opportunity to view a video in which Lee shared his positive experiences.
An oesophagectomy is a two-stage procedure performed within both the abdomen and chest. Both stages of the procedure, to remove a tumour from Lee’s oesophagus, were carried out robotically. Remarkably, Lee Moreton was discharged just five days post-surgery, two days earlier than average, with no complications. During the video interview, Lee commented on
how being able to go home quicker had improved his experience and helped with his recovery: “Being at home and being in your own bed is a massive plus!” he noted, pointing out that he was able to rest better in a quiet environment. Nationally, the average length of stay for oesophagectomy patients ranges from seven to 13 days across different centres. NNUH has an excellent track record, with a current average length of stay of seven days – making it one of the top performing centres in the country. Nicholas explained that the case was very
challenging due to the tumour being densely adhered to the lining of the heart and airways following radiotherapy treatment. “Previously this would have necessitated the
procedure being performed through an open thoracotomy incision. However, the improved 3D vision, dexterity and precision of the robot allowed the procedure to be performed minimally invasively through small incisions. The hope is that this type of robotic surgery will continue to reduce complications such as pneumonia following surgery, reduce length of stay and aid in a quick return to full function for our future oesophagectomy patients.”
Expanding access to robotic surgery With over 50 robotic surgeries performed under his leadership at NNUH so far, Nicholas remains dedicated to making robotic-assisted surgery more accessible. He strongly advocates for
increased investment in robotic technology and surgeon training, noting that robotic surgery offers significant benefits over previous techniques, including reduced pain and blood loss, fewer complications, shorter hospital stays and quicker recovery times. The surgery requires only very small
incisions, which are possible thanks to the use of miniaturised cameras and instruments, controlled remotely by a surgeon, via the robotic system’s console. This allows greater visibility and precision than would be available in conventional techniques, making procedures easier for surgeons and safer for patients. “We do highly complex surgeries, lasting
many hours, and each member of the team has an important part to play,” said Nicholas. “Each surgery is a real team effort. During robotic surgery the surgeon is not directly next to the patient, and you need total trust in your team and good communication is key. I know I have a great team around me, and it makes all the difference.” Nicholas believes robotic-assisted
procedures should become the gold standard in oesophagogastric surgery. However, further development is required to improve access. As a dedicated educator, he actively contributes to both undergraduate and postgraduate surgical training, and trains surgeons throughout the region. He said that he feels privileged to do robotic surgery: “It is hard, and can be stressful at times, but the results and outcomes are so clearly evidenced to be so much better for the patients which makes it all worthwhile.”
The present and future of surgical robotics Mr Jonathan Morton, a Consultant Colorectal Surgeon in Cambridge, has a special interest and formal training in human factors and its application in healthcare, with a diploma from IATA in airline safety system management. He has over 10 years of MedTech experience, including as an Associate Medical Director for CMR Surgical.
During his session, he provided an overview
of the history and future of robotic surgery, discussing the benefits, the adoption of robotic surgery over time, and the key technological advancements that have enabled the growth of robotics in surgery. He also explored future trends in miniaturisation, digital technology, and data integration, as well as the potential impacts on surgical education, training, and patient safety. He explained that robotic surgery has been
Versius robot from CMR
around since the 1980s, with the development of systems such as ROBODOC for hip replacements and PUMA 500 for brain biopsy. In the 1990s, we saw the Da Vinci receive CE approval in
Europe and in 2001 we saw the first telesurgery procedure. In the 2019, CMR Surgical’s Versius system received a CE Mark and Medtronic revealed the development of the Hugo system. Jonathan pointed out that, in the last five years. we have seen a plethora of other robotics companies that are now entering the market, which are at various stages. Robotic surgery offers benefits over
traditional open and laparoscopic techniques, including improved vision, tremor filtration, and dexterity with wristed instruments. Minimally invasive surgery reduces the risk of surgical site infection and, as there is increasing resistance to antibiotics, this is becoming an important consideration for surgical practice. The adoption of robotic surgery has been
driven by factors like improved patient outcomes, and reduced length of stay. Barriers to wider adoption include cost, access to training, and the need for stronger evidence- based data on the benefits of robotic surgery. However, one of the key advantages of robotic surgery over laparoscopic surgery is the high- definition and stability of the vision. “You haven’t got your assistant getting bored
halfway through a long laparoscopic case and their mind wandering onto other things, or the trainee holding the laparoscope getting distracted and working in the field of view. He further highlighted the “seven degrees of freedom” which wristed instruments provide. “Tremor filtration has been a key part of
robotics,” he commented. “There are natural tremors for all of us. As someone who’s been working in the NHS long enough to have seen three different pension ages so far, I suspect this may be quite an important aspect of robotics going forward,” he continued.
Robotic surgery adoption Jonathan explained that the Da Vinci was originally developed as a battlefield robot with the aim of enabling surgeons to perform surgery from a remote position. “They launched mainly into cardiac surgery, but it was really urology that gave DaVinci its business case,” he explained. He went on to highlight NHS data on two decades of robotic surgery, showing the huge impact on surgical practice. “Back in 2000, the predominant method
of performing a prostatectomy was open; laparoscopic surgery gained some traction in the noughties, until around 2010/2011. But very much like the oesophagectomy story, it’s extremely technically demanding, and a lot of surgeons were really struggling to get safe and effective outcomes. So, robotics came along, and we have seen exponential growth in robotic prostatectomies,” he explained, adding: “Where
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