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Robotic surgery – an answer to the NHS backlog?

Grant Stewart is Professor of Surgical Oncology at the University of Cambridge and Consultant Urological Surgeon at Addenbrooke’s Hospital in Cambridge. We made contact with Grant after a BBC News story reported that surgical robotics was helping to cure patients with prostate cancer and enabling them to go home within less than 24 hours of surgery.

The Medical Technology Group sat down with him to discuss how robotic surgery can be used on the NHS, the wider implementation of medical technology and the future of our health service.

The news from Addenbrooke’s this summer was very promising in terms of tackling the backlog of cancer care treatment. Could you tell us a bit more about this?

GS: Robotic surgery has been going on at Addenbrooke’s since the early 2000s. It emerged as an alternative to standard keyhole surgery – which was really challenging to learn. It is a bit like trying to pick something up with the tip of a knitting needle and so unsurprisingly it is difficult to master. Robotic surgery changed all of that – the dexterity was improved, there was a 3D view and it was much easier to learn. Outcomes were generally as good, if not better, than normal keyhole surgery or traditional open surgery.

Our robot in Cambridge is now one of the busiest in the UK – being used for urology surgery six days a week. We now want to develop a multi-specialty programme that can treat other types of cancer – bowel, liver, pancreas, gynaecological and head and neck. We’re about to acquire a second robot, funded by the Addenbrooke’s Charitable Trust.

Commissioners are often reluctant to take up expensive medical technology such as this. What message do you have with regards to the benefits of investing in such technology from a clinical perspective?

The benefits are clear. If we can do an operation safely, with excellent cancer outcomes and discharge someone on the first day after surgery rather than the fifth we save four bed days. One of the biggest problems we have right now in the NHS is availability of beds – it’s a real pinch point. In this sense surgical robotics play a role in creating more capacity.

There is no doubt that this sort of technology should be encouraged where there is good evidence that it is superior to the open surgery it’s replacing. But it’s key that its uptake is done in a safe environment with the appropriate volume of surgery and the outcomes audited. You don’t want a robot being a ‘white elephant’, used intermittently and therefore not safely.

 What are your thoughts on the wider implementation of medical technology in the NHS?

The key point is that technology needs to be introduced in a safe way. In the not-so-distant past some technologies have been introduced with minimal evidence. Moving forward we need to make sure we develop the evidence for the implementation of these technologies well. There are strong strategic groups developing the evidence for new devices.

Having just returned from a professional visit to the US, I’m much more optimistic about what we do here in Britain. We work well together and the NHS allows us to test lots of new treatments in an effective way.

December 2022

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