NHS robot surgery revolution 'will help cut waiting times'

Health chiefs have hailed a robotic surgery revolution that will slash recovery times and help to cut NHS waiting lists. The "trailblazing technology" sees surgeons control a robotic system to operate with extraordinary precision, reducing pain and complications for patients. A major expansion will see the number of procedures performed this way soar from 70,000 to half a million per year over the next decade.

Writing in the Express, NHS national medical director Professor Meghana Pandit says this technology is "quickly becoming the norm" and will help build a health service "fit for the future". She adds: "As robotic assisted surgery continues to develop and scale up across the NHS, so does the potential to improve patients' recovery times, increase surgical accuracy and reduce complications from invasive procedures, in turn helping to reduce pressure across the system and cut waiting times."

NHS plans will see nine in 10 keyhole surgeries - those done through small incisions rather than a large opening - delivered this way within 10 years, up from one in five today.

Robotic-assisted surgeries can be slightly faster than manual procedures when performed by an experienced surgeon. But the main benefit for patients is a much quicker recovery and fewer complications. It means more patients can be treated as people are released from hospital sooner.

The Daily Express scrubbed up to watch medics perform keyhole surgery with robotic assistance at Guy's Hospital in London - home to the UK's largest and most active thoracic surgery department.

As half of the patient's left lung was pulled through a golf ball-sized hole in her chest, the department's lead surgeon Tom Routledge said: "She'll be awake within half an hour, sitting up in a chair and having a cup of tea."

The procedure to remove tissue containing a small tumour took around an hour and a half. For most of that time, Mr Routledge and his apprentice sit at twin consoles two metres away from the patient.

The senior medic, 53, helped to pioneer use of robotics in the NHS. He says: "When I started doing this 10 years ago, it was relatively novel, kind of a niche thing that a small number of enthusiasts did to develop the techniques.

"Now, it has very much moved into the mainstream. The surgical community understands that this is the way the majority of this type of surgery should and will be done going forwards."

The robotic arms are inserted through four small incisions and have articulated "wrists" to allow precise, smooth movements. One holds a camera while the others wield instruments.

Mr Routledge works as a proctor, supervising surgeons learning to use the technology. Dr Christoph Zacherl, 35, has come from Austria to spend a year training in London.

Viewing the anatomy through a 3D display, the trainee - who has performed the same operation by hand hundreds of times - uses a cauterising tool to slice through blood vessels with minimal bleeding.

The da Vinci Xi system's dual controls allow Mr Routledge to take control when needed to help tackle more "anomalous arteries".

Learning to operate the robot is a bit like learning to drive a car, he explains. Trainees have already mastered the basics of manual surgery. They then practice using simulators and animal models before joining real operations.

It takes time to "move from it being a bit clunky and having to think about what to do, to getting ever more fluid and controlled like an experienced driver", Mr Routledge adds.

As Dr Zacherl carefully dissects the fragile vessels, other members of the 10-strong theatre team remain at the bedside, monitoring the robotic arms, providing suction and cleaning the camera lens when required.

Analysis of data from Mr Routledge's operations shows that around 7% of patients suffer complications after robotic-assisted procedures, compared to 20% with open surgery and 15% with video-assisted keyhole surgery.

"Surgeons obsess rightly and endlessly about pain," he says. "We're very aware that unlike a lot of treatments, surgery upfront hurts and is destructive to tissue. Robotics has at least the potential to be less painful than other ways of doing surgery."

The lung cancer patient can expect to spend a couple of nights in hospital, rather than three or four if the operation had been performed manually, Mr Routledge adds.

"So she'll go home a couple of days early, but more importantly, she'll have a safer recovery and get back to a fully active life more quickly."

The technology also benefits surgeons. Regularly carrying out manual keyhole surgeries is "quite brutally destructive of surgeons because you're spending hours in these odd and uncomfortable positions", Mr Routledge says.

Musculoskeletal damage is common and can force doctors to end their careers up to a decade early. The discomfort also impairs decision-making.

Mr Routledge adds: "Your ability to make decisions during a difficult, long operation, particularly under periods of high stress such as an emergency, is better if you're sitting comfortably and relaxedly at a robot."

We watch on the screens as Dr Zacherl removes a lymph node. It will be sent to the hospital's lab for analysis, to check for signs that the cancer has spread. He selects a different tool to tackle larger blood vessels, firing rows of tiny titanium staples before cutting through the tissue.

Mr Routledge tells us: "The complication that we fear most during this type of surgery is small tears to those blood vessels because you can have a nice controlled operation like this that rapidly becomes a life-threatening situation."

A portion of the lung is sliced off, placed into a bag and the air squeezed out before it is extracted through one of the incisions. The operation has run like clockwork. The team will begin the second of three daily operations within an hour.

This technology is constantly improving - newer models can operate with multiple arms inserted through one incision, and will feature haptic feedback so surgeons can feel how much pressure they are applying.

Guy's and St Thomas's NHS Foundation Trust is the UK's largest robotic surgery centre and performs 800 operations to remove all or part of a diseased lung every year.

Robotics is also used across six other specialities including urology, gastrointestinal and transplant surgery. Over 12,000 patients have benefitted from da Vinci-assisted procedures at the trust since the first device was installed in 2004.

Mr Routledge, who uses robotic assistance in 99% of his procedures, says patients are usually comfortable with it once they understand it. Some envision AI robots conducting the entire operation - but this remains the stuff of science fiction.

The surgeon adds: "AI controlled surgical robots will be quite slow to come because of safety concerns, and because of patients' emotional wish that their surgery and healthcare is delivered by a human being."

The National Institute for Health and Care Excellence recently approved 11 robotic surgery systems for soft tissue and orthopaedic procedures.

More than 200 da Vinci systems, made by tech company Intuitive, are in use at hospitals across the UK. Health Secretary Wes Streeting was treated for kidney cancer using da Vinci surgery at the Royal Free Hospital in 2021.

The da Vinci Xi costs around £1.5 million, with the price varying depending on the exact set-up chosen by the hospital. This is comparable to mid-range hospital equipment and less than radiotherapy machines or advanced MRI scanners.

Robotic keyhole surgeries are more expensive than manual ones, but money is saved elsewhere through earlier discharges, reduced bed days and a lower rate of complications.

Mr Routledge adds: "What matters is the value for money. Complications of surgery have a devastating human cost, but they're also fabulously expensive."

Ashley Dalton, Minister for Public Health and Prevention, told the Express the technology was "liberating clinical teams to focus resources where they are needed most and cutting waiting lists even further".

She added: "By deploying this incredible technology, NHS hospitals like Guy's and St Thomas's are investing in people, not just machines."

Dr Jesme Fox, medical director for Roy Castle Lung Cancer Foundation, welcomed the expansion of robotic-assisted surgery. She said: "From a lung cancer patient perspective, minimally invasive surgery, with robotics, means that patients spend less time in hospital and have a speedier recovery, than with conventional open chest surgery.

"It is not appropriate for everyone but, where it is feasible, it is definitely a step forward and good to see it being more widely available. Ultimately, we want to see lung cancer patients diagnosed early, when potentially curative treatment, as with surgery, is possible."

David Marante, vice president of Intuitive UK & Ireland said: "We're pleased to support the care teams at Guy's and St Thomas's NHS Foundation Trust whose highly efficient programmes are a great example of how implementing minimally invasive care throughout the patient pathway, with da Vinci robotic-assisted surgery and Ion bronchoscopy, can help increase productivity, improve patient and care team experience, deliver a lower overall cost of care and ultimately, improve patient outcomes.

"At Intuitive, we're committed to supporting the UK Government's aim to expand access to robotic-assisted surgery, as outlined in the 10 Year Health Plan, so that more patients can benefit from minimally invasive care."

Patients being operated on by robots may sound like a scene from science fiction - but this trailblazing technology is quickly becoming the norm in the NHS - and is a crucial part of building a health service that is fit for the future.

We estimate that half a million operations will be robot-assisted each year within the next decade - a huge increase from the 70,000 completed in 2023/24, and shows just how quickly this cutting-edge work is developing.

Robotic assisted surgery can be more precise than the human hand and have been proven to result in faster recovery and shorter hospital stays for patients - just two of the hugely important benefits which further relieve pressure on services.

Like the work being done at Guys and St Thomas' NHS Trust - who are using several different platforms of advanced robotics across specialities including urology, gynaecology and transplant surgery, resulting in better patients' outcomes and shorter hospital stays.

It is a perfect example of using innovation to improve patient care that is transforming the way the NHS works.

Robotic assisted procedures are expected to become the default for around nine out of ten keyhole surgeries - such as the removal of certain organs affected by cancer - within the next 10 years.

The National Institute for Health and Care Excellence, who provide evidence-based guidance and advice across the health system, recently approved a further 11 platforms for soft tissue and orthopaedic procedures, laying the groundwork for a further ambitious expansion.

Recently, we published our first ever national guidance on delivery of robotic programmes in NHS hospitals to ensure patients across the country can benefit from these developments in the safest way possible.

The 10 Year Health Plan identified robotic surgery as one of its five "big bets" that will be essential in delivering the new model of care. Having transformed surgery in recent decades, it is set to transform patient care and support - from providing patients with continuous monitoring, to precision rehabilitation, to prosthetic limbs that support recovery from neurological or musculoskeletal injuries.

As robotic assisted surgery continues to develop and scale up across the NHS, so does the potential to improve patients' recovery times, increase surgical accuracy and reduce complications from invasive procedures, in turn helping to reduce pressure across the system and cut waiting times.

The NHS has pledged to return to shorter waiting times for planned care by 2029, and the expansion of this new and exciting tech shows we are using every tool in the box to ensure the best outcomes for patients now, and in the future.

- Professor Meghana Pandit is NHS England's National Medical Director

Hear the words "robot-assisted surgery" and thoughts may turn to the high-tech future of the USS Enterprise sickbay. A future in which medics and robotic AI assistants work seamlessly together.

Surgical procedures, drugs, and therapies, created against the clock to save crewmates infected with alien bugs, or wounded on missions to strange new worlds.

But this marriage of human and machine intelligence isn't a 23rd century fantasy, it's real and it's happening now.

Robotic devices are already transforming treatment and discharge times for thousands of NHS patients to the tune of 70,000 operations in the last year alone.

Spurred by this success, we're aiming for half a million robotically assisted operations, every year, by 2035.

In 2023, a patient underwent a total hysterectomy by robotic surgery. They left hospital the next day, only requiring paracetamol to manage recovery.

And in the field of urology, hospital stays have been reduced from 10 days to eight, with significant reductions in re-admittance also reported, thanks to this groundbreaking technology. This is our 10 Year Health Plan in action, innovation at warp speed to deliver faster, safer care.

Within a decade, NHS clinicians expect nine out of ten keyhole procedures to be carried out robotically. The benefits? Greater precision than the human hand, faster recovery, shorter hospital stays.

It's good news for the NHS workforce too, liberating clinical teams to focus resources where they are needed most and cutting waiting lists even further. This is what our Plan for Change will deliver for patients and staff.

By deploying this incredible technology, NHS hospitals like Guy's and St Thomas's are investing in people, not just machines. This is how we boldly build the NHS of the future, today.

- Ashley Dalton is Minister for Public Health and Prevention