“In a time where infection exposure is rife, minimally invasive robotic surgery is likely to become more prominent,” he explains. “It allows patients to return home quicker with less pain and feeling stronger. Enhanced recovery means patients are less exposed to Covid-19. Shorter stays also play a vital role in maintaining bed capacity within hospitals.”
The cost benefits to health services at a time when resources are strained are also considerable.
Lam continues: “We’re seeing the greatest demand on healthcare for centuries, so it’s vital hospitals have the capacity to meet the needs of the more complex and time-critical patients. Given the financial crisis experienced during Covid-19, this beneficial effect will impact on the long-term overall direct and indirect costs to the patient and society.”
For the surgeon, robots provide peace of mind. Their accuracy removes the margin for human error, thereby reducing the risk of revision surgery.
“It is also quicker,” says Lam. “It allows me to insert a screw in three minutes. Without the robotic assistance, the same procedure would take 10 minutes.
“There is less pain, less anaesthetic. Recovery with open surgery would be three months. Now 95 per cent of my patients are back at work in two weeks. They can start physio too because the fixing is more stable.”
The first robot-assisted procedure took place in 1985, when the PUMA 560 robotic surgical arm was used in a brain biopsy. Fifteen years later the da Vinci Surgery System became the first robotic system approved for general laparoscopic surgery. In 2004 the NHS began using one at Guy’s and St Thomas’ Foundation Trust in London. Since then the system has been used in more than 70 NHS hospitals.
In 2016 surgeons at John Radcliffe Hospital, Oxford, carried out the world’s first robot-assisted internal eye operation. And in 2018, The Royal Marsden performed the UK’s first robotic total pelvic exenteration using a da Vinci system. In the procedure the robot helped surgeons remove all the organs from the pelvic area of a patient with advanced rectal cancer.
Despite the advantages, uptake in the NHS has been slow. Today only 15 per cent of surgeries are robot-assisted. The figure could be much higher.
Lam says: “Robotic surgery is trickling down to the NHS. While the machines are not cheap, they allow you to get it right the first time, so save costs on revisions. All surgeons can make errors – even the best. The machines are much more accurate. It makes financial sense to have them in key centres.”
Uptake rate could be changing, however. Last year the NHS announced a £50m fund for robotic surgical equipment and recently the Western General Hospital in Edinburgh and Milton Keynes University Hospital NHS Trust became the first two centres in Europe to use newly approved next-generation Versius robots in a range of colorectal surgeries.