It looks a bit like a video game, but the NHS is betting it can help cut hospital stays and waiting lists.
Surgeons in the UK are training in robotic keyhole surgery as part of a push across the National Health Service to expand the technology. The government has set a target for robotic assistance to be used in 9 out of 10 keyhole surgeries in England by 2035.
At St Bartholomew’s Hospital in central London, consultant thoracic surgeon Sasha Stamenkovic recently used the new da Vinci 5 robotic-assisted surgical system, made by US company Intuitive, to remove a tumour from a patient’s lung while three surgeons from another English hospital observed.
“We’ve done some very, very intricate operating today,” said Stamenkovic, a 60-year-old consultant thoracic surgeon. “We’ve saved a lot of lung, we’ve gone around some really, really small vessels and really small airways.”
Throughout the roughly two-hour operation, Stamenkovic gave instructions through a microphone to his surgical team, including nurses specially trained as robotic surgical first assistants.
As director of robotic surgery and research at Barts Health NHS Trust, he runs fellowships and said he is shaping what will be the “surgeon of the future”.
Stamenkovic operated from a console at the side of the room. His hand movements controlled three robotic arms holding surgical instruments over the patient, while a fourth arm held a camera that provided a 3D view for the surgeon and two screens in the operating theatre.
The systems can be used in urology, gynaecology, colorectal, thoracic, and abdominal or general surgery.
Ali Ansaripour, a senior cardiothoracic trainee on a year-long fellowship, said “stepping away” from the patient and adjusting to the setup was the “biggest challenge”.
“I think that almost kind of separates you from the patient slightly,” he said. “But it gives you incredible vision and makes you very objective in terms of how you deal with the patient.”
Stamenkovic said robotics has brought keyhole surgery closer to “how the original open surgery used to be” because the slim robotic arms can move more easily than humans using tools in the restricted space of keyhole surgery.
“Robotic surgery has brought you back to what surgeons wanted to do, which was to have an art form able to create something with their hands,” he said.
He said the greater precision also reduces the risk of complications like air leaks, a common cause of longer hospital stays after lung surgery.
The hope for the NHS is that more precise surgery through a smaller wound will shorten hospital stays and recovery time, helping patients leave sooner, freeing bed space and reducing waiting lists.
Ian Macleod, 76, said he only learned he would be the first NHS patient to undergo lung cancer surgery using the new system when he was already in a surgical gown and about to be anaesthetised.
The retired detective said the news “didn’t faze” him and that he was back on his feet 30 minutes after returning to the ward.
The recovery was “extraordinary,” Macleod said. He said he had previously undergone non-robotic keyhole surgery for a different cancer and that recovery time was “much longer”.
He left hospital with one stitch and said he was driving his wife to the garden centre for coffee less than a week later.
The government has highlighted robotics as one of five “big bets” in a 10-year health plan for England.
But the Royal College of Surgeons of England has criticised a “postcode lottery” in access to robotic surgery across the country. It also criticised the lack of a “standard, consistent funding model” for robotics across the NHS, saying some hospitals rely on charitable donations to buy the equipment.
“We need to embed robotics into training programmes,” Stamenkovic said.
“All we need to do is harness their energy, their passion, their skill set, and teach them the right moves.”
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