INTEGRATED THEATRES


The benefits of da Vinci robotic- assisted, minimally invasive surgery have been explored in more than 15,000 peer-reviewed publications. These publications demonstrate that RAS enables surgeons to offer their patients a minimally invasive surgical option which can result in fewer complications, shorter hospital stays, less blood loss, fewer readmissions, and quicker recovery,1-6


when compared to


open surgery. Some of these outcomes are outlined below in more detail.


Lower rates of complications Complications from surgery can include bleeding, damage to adjacent structures, pain, infection, blood clots and more.7


The ability for hospitals to


minimise complications is critical to improving care and reducing costs. Comparative data of complication rates across RAS, traditional laparoscopic, and open procedures shows that RAS can reduce these rates.1-6


Shorter hospital stays Based on published comparative studies on length of stay, RAS has been shown to have an advantage here when compared to laparoscopy and open surgery.1-6


Not only does shortening the


length of stay present the opportunity to reduce costs for hospitals, Trusts and the NHS, it can also mean that patients return home and resume their lives quicker. Additionally RAS can, for some procedures, eliminate the need for patients to remain in the hospital overnight. This can help to ease the pressure on hospitals around bed shortages.


Less frequent conversions to open surgery One challenge surgeons can face while operating is conversion. Conversions happen when complications during surgery require the surgeon to change from a minimally invasive procedure to an open one. Conversions can lead to more complications, longer hospital stays and higher costs. Comparative studies on conversions have shown surgery performed with RAS can have an overall advantage compared to that of laparoscopy in various procedures.8,9 The above summarise some of the clinical benefits that can be associated with minimally invasive, robotic-assisted surgery. Each of these clinical benefits


It is sometimes incorrectly assumed that ‘robotic surgery’ means displacing surgeons with machines. That is not the case.


can deliver cost-savings; meaning that RAS can create opportunities for savings associated with the total cost-to-treat patients from the operation to discharge and beyond. As robotic-assisted surgical system use and utilisation grows within and across indication areas, there is also potential to drive efficiencies for surgeons, OR theatre teams, hospitals and healthcare systems.


Advancing from the front line The original prototype for the da Vinci Surgical System was developed in the late 1980s at the former Stanford Research Institute under contract to the US Army. While initial work was funded in the interest of developing a system for remotely performing battlefield surgery, possible wider access surgical applications were even more compelling. In 1995 Intuitive Surgical was founded, and in January 1999 it launched the da Vinci Surgical System. Five years later, the da Vinci Surgical System became the first robotic- assisted surgical system cleared by the FDA for general laparoscopic surgery. Today, more than 5 million robotic- assisted da Vinci procedures have been performed globally, with 875,000 performed in 2017 alone. Every 36 seconds, somewhere in the world, a surgeon begins a da Vinci robotic- assisted surgical procedure. Around the world, RAS is used for


surgeries including:10 n Colorectal surgery (colon or rectal cancer)11


n Urology (prostate, bladder and kidney cancer, urinary obstruction)12


n Gynaecology (benign and cancerous hysterectomy, myomectomy etc.)13


n General surgery (bariatric, gastrectomy, hernia repair, etc.)14


n Thoracic surgery (lobectomy)15 n Cardiac surgery (mitral valve repair, pulmonary resections)16


n Head and neck surgery.17 Surgeons throughout the UK have been at the forefront of driving innovation using RAS following the introduction of the da Vinci surgical system in the UK 10 years ago. In the UK, RAS is well- established and nationally


commissioned for use for prostate and kidney cancer, and its use is growing in other areas, such as cystectomy, gynaecological cancer, colorectal cancer and being introduced in newer areas such as cardiothoracic surgery and head and neck cancer. In the UK between 2006/7 and 2014/15, MIS use and volume increased by 66%. In 2014/15 75% of MIS prostatectomies (procedures for prostate cancer) and 27% of MIS partial nephrectomies (procedures for kidney cancer) were performed robotically. Taking past trends into account, this number will likely rise; in 2006/7 only 34% of MIS prostatectomies were performed robotically, with no robotic surgeries performed for partial nephrectomies.20


The future of RAS When looking towards the future, RAS and associated technologies can help to assist in delivering the increased - and increasingly efficient - surgical capacity needed for a stretched NHS. Innovation will have a significant impact on surgery and, as more companies produce new technologies and diagnostic imaging for use with RAS systems, the future promises to bring about some exciting advances. Looking forward, the ‘pillars’ of minimally invasive innovations being focused on include less invasive approaches/technologies, intelligent systems, enhanced imaging, data analytics and optimised learning. These elements can support a reduction in surgical variability, which can enable improvements in patient outcomes (quicker recovery, leading to productivity and improved quality of life), increased OR team efficiency, advanced efficiencies in hospitals, and provision of solutions to wider systemic challenges. Such challenges include increasing the surgical capacity within the NHS to cope with an ageing population, increasing hospital bed availability by reducing length of stay and/or facilitating the use of ‘day-case’ surgery.


RAS is a key example of how investment today in technology and


OPERATING THEATRE l JULY 2018 l 19


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