Robotic Surgery – Transformation?
Thursday, 14 January 2016
Ms Justine Royle, Consultant Urologist, NHS Grampian.
Medico-Chirurgical Hall at 7.00 pm (preceded by a finger buffet from 6.00 pm)
Surgical robots came to England in the first decade of the 21st century. It took Scotland until half way through the second decade to get its first. Aberdeen was lucky enough to get it. Come and listen to why this happened and how it is transforming surgery in Grampian.
Note for Society Meeting 14thJan 2016
The President welcomed the company to the meeting and made announcements about the forthcoming Burns Supper (22/1), a charity concert at Queens Cross Church in aid of Médecins Sans Frontières (6/2) and the Society’s ‘Famous for Five Minutes’ fund-raising event (21/5). He then invited Miss Justine Royle, Consultant Urologist, Aberdeen Royal infirmary, to give her presentation entitled: ‘Robotic Surgery – Transformation’.
Miss Royle explained that when she came to Aberdeen 7 years ago, after completing her training in Edinburgh, she introduced laparoscopic prostatectomy. She confessed that, as this procedure was such an advance on previous open techniques, she had initially been reluctant to believe that robotic prostatectomy was either advantageous or necessary. She then proceeded to tell us why she had been wrong and shared how enthused she has become with robotic surgery, and how it is indeed a great advance for surgical teams, as well as their patients.
Prostate cancer shows a continuing rise in incidence, with a near-doubling in the need for open prostatectomy in Aberdeen from 36 cases in 2007, to 69 in 2014, so there is certainly an increasing imperative to make treatment as efficient and effective as possible.
Robotic surgery, first used regularly in some centres across the world from about the millennium, has been becoming more widespread across the United States and Europe and there were 40 robotic surgery kits in England before there were any North of the Border. Miss Royle described her involvement in national discussions with Specialty Groups and the Scottish Government which had culminated in Aberdeen getting funding to allow commissioning of the first robotic surgery facility in Scotland in August 2015. She acknowledged the major contributions of the UCAN local charity support which had led to the local service being well-organised and documented, and the ambition and foresight of the NHS Grampian Board in encouraging acquisition and implementation of the new system.
Miss Royle described and illustrated the components of the robotic surgery set up, in which the real difference is the use of a remotely operated set of instruments, under visual and manual control of a surgeon seated adjacently. In appropriately selected procedures, including resection of prostatic cancer, the surgery can thus be conducted with greater precision, dexterity and operative field view than can be managed manually. The operating unit has interchangeable instruments which can be re-used up to 10 times; sterilisation procedures between operations have hitherto required the use of a special facility in Newcastle but Grampian’s own equipment for this purpose is due to be operational by next month.
Much was said about the strategy and delivery of training in robotic surgery. The local urology unit decided to train a group of consultants simultaneously – which altered the economics of having visiting experts, from a number of UK and European sites, come to Aberdeen. Local specialists also visited functioning robotic surgery set-ups elsewhere. There was clearly a major advantage for training in acquiring two operator consoles, as is the case in Aberdeen, in that it afforded the opportunity for two surgeons to simultaneously watch and share procedures. It had also been appreciated from an early stage that preparation needed to involve appropriate training of the whole theatre team and not just primary operators. Furthermore, it had to be expected and accepted that the time required to train and prepare for robotic surgery would inevitably deplete the service temporarily – with anticipated consequences for waiting times.
Additional difficulties for anaesthetic practice was also acknowledged in that the robotic surgery kit makes the patient less directly accessible to the anaesthetist and the superiority of the surgical technique will lead to operative interventions now being deemed possible in patients with greater co-morbidity and greater body mass index.
Early experiences of using robotic surgery for prostate cancer in Aberdeen were described – and were very favourable. Around 20 prostate operations had been performed by November and case numbers are rising towards 40. Operating times are currently around 2 hours with in-patient stay reduced to an average of about 1 day! Post-operative complications are much fewer, particularly in terms of leaks and potency. Oncological outcomes – initially assessed in terms of clear tumour margins - have remained ahead of recommended standards and are improving further with experience. A small number of bladder procedures had been carried out with, if anything, greater implications for reduced post-operative morbidity and length of hospital stay.
Those conducting the surgery are rapidly gaining experience and expertise and are even more rapidly convinced of the advantages of robotic surgery over laparoscopic procedures in appropriate surgical circumstances. Already there is pressure on theatre time and consequent upon the greater range of patients whose disease will now be considered operable, and in-flow of patients from other regions for the procedure available in Aberdeen. Other surgical disciplines are also increasingly keen to follow urology into robotic surgery and there are hopes that, with its current head start in Scotland, Aberdeen could perhaps become an established training centre for this emerging field.
A lively question and answer session followed illustrating how the speaker’s enthusiasm had quickly transferred to her audience. The President proposed the vote of thanks and the meeting closed.