Millions to benefit from NHS robot drive

Millions of patients will benefit from cutting-edge NHS robotic surgery over the next decade as part of radical plans to cut waiting times.

Half a million operations will be supported by the trailblazing approach every year by 2035 – up from 70k in 2023/24 – according to NHS projections.

Nine in ten of all keyhole surgeries, such as the removal of certain organs affected by cancer, will be delivered with robot assistance within the next 10 years - up from one in five today with robotic surgery being the default for many operations.

The NHS also expects to see increasing numbers of emergency operations using the space-age tech - which can be more precise than the human hand.

The new NHS England forecast follows the publication of its first ever national guidance on how robotic programmes should be delivered.

Sir Jim Mackey, NHS chief executive, said:

“The NHS has pledged to return to shorter elective waiting times by 2029 and we are using every tool at our disposal to ensure patients get the best possible treatment.

“Expanding the use of new and exciting tech such as robotic surgery will play a huge part in this.

“Not only does it speed up the number of procedures the NHS can do, but it also means better outcomes, a faster recovery and shorter hospital stays for patients.”

Compared to traditional keyhole surgery, robotic surgery allows greater dexterity and is easier to manipulate as the instruments are controlled by a surgeon at a console using a 3D camera. In orthopaedic robot procedures, the robot is programmed to perform elements of the procedure

Patients undergoing surgery involving robots are able to recover quicker and be discharged sooner, with some bladder cancer patients leaving hospital in just five days - half the expected time with traditional open surgery.

In particular, robotics will be increasingly used as part of keyhole surgery, where a surgeon uses only small cuts and a camera to minimise damage to tissues

In recent years, the range of operations involving robots has widened – in 2011/12 urological cancer surgery made up 80%, but by 2023/24 this relative proportion dropped to 44% even though the number of operations had increased, as there was significant growth in areas such as colorectal, gynaecology, ENT and orthopaedic procedures.

Five systems for soft tissue procedures – such as hernia repair, removal of tumours, and gallbladder removal, and six for orthopaedic surgery – such as full and partial knee replacement procedures and hip replacements – have received conditional approval from NICE while they undergo further evaluation, meaning the use of this technology can be expanded further across the NHS to help thousands more patients.

John McGrath, consultant surgeon at North Bristol NHS Trust, and chair of the NHSE Steering Committee for Robotic Assisted Surgery, said:

“Robot-assisted surgery is a perfect example of innovation improving patients' care and transforming the way the NHS works - the number of procedures being carried is set to rapidly grow over the next 10 years according to our analysis. 

“As keyhole surgery continues to develop and scale up in the NHS, it is likely that many of these procedures will be provided with degrees of robot assistance in the future – importantly as the costs come down and efficient patient pathways are embedded in robotic programmes.

“Faster recovery and shorter hospital stays are not only hugely important benefits for patients undergoing surgery, if used efficiently they can have a positive impact on the rest of the system by relieving pressure on services and therefore helping to reduce waiting times.

“Robot-assisted surgery can also make complex operations less physically demanding for surgeons, with the potential to reduce strain on surgical teams, allowing a greater number of complex surgeries to be carried out each day.

“The approval of 11 systems by NICE was a milestone in the continuing development of this technology and our newly-published national strategy will help ensure patients across the country are able to access this treatment when they need it, regardless of location.”

Health and Social Care Secretary Wes Streeting said:

“Innovative treatments and technologies that help fast track better outcomes for patients is how we transform our NHS and make it fit for the future. I know myself how important this is, when the NHS saved my life from kidney cancer with an operation led by a world-class surgeon being helped by a robot.

“Whether it's robotic surgery, our new health data research service to accelerate the development of new medicines, or announcing new artificial intelligence that detects skin cancer, our Plan for Change is driving forward new ways to help cut waiting lists and get patients treated on time again.

“We have put a record £26 billion into our NHS and social care which include cash to bring more cutting-edge tech into the health service to boost productivity, speed up recovery rates, and get people back to their best as soon as possible.”

Case studies

Nichola Collins of Thornton-Cleveleys, had a hysterectomy at Chorley and South Ribble Hospital in Lancashire, and was home within 24 hours – which was “significantly quicker” than she expected.

Nichola said: “I only knew about the old way of doing a hysterectomy, and that often meant two to four days in hospital – sometimes even a week. One of the main reasons I opted for the robotic procedure was because I've got young children, four in all. I didn't want a long recuperation afterwards, so it was a big benefit.

“My recovery has been significantly quicker than I would have thought. I followed the advice I was given and took it easy, mostly resting. But from about week two, I was up and about more, moving around, even going downstairs. The procedure went perfectly.

“It's made a huge difference to my quality of life. I had been dealing with ongoing issues, and since the surgery, things have improved a lot.”

She added: “I was amazed at how they could do something so intricate using robotic arms, I found it incredible. I just felt really lucky to have been offered that option, especially with my family circumstances. The better recovery meant I could get back on my feet much sooner and carry on with everyday life, so I just think it's amazing that they can do it.”

Earlier this year Mohammed, a four-month-old boy from Manchester became the youngest child in the world to successfully have surgery using the Versius Surgical System.

The operation to remove part of a narrow kidney tube, was carried out at Royal Manchester Children's Hospital (RMCH), part of Manchester University NHS Foundation Trust (MFT), in a clinical study on the use of Versius in paediatric surgery.

Mohammed weighed just 6kg, when he underwent a pyeloplasty operation; surgery to treat a narrow ureter (the tube that connects each kidney to the bladder). 

Pyeloplasty surgery aims to restore the drainage of the kidney, prevent urine infections and in older children, is a cure to episodes of severe pain called Dietl's crisis, which can occur with this condition. 

Mohammed's Mum, Mariam said: “As parents we were worried about Mohammed's narrow ureter because of the risks of him getting infections which could damage his kidneys.  

“We didn't think it would be possible for him to have the surgery needed to fix the problem at just four months old. We thought that he would be too small. It was a huge relief when we found out that he wouldn't have to wait because doctors can operate so precisely using the robotic system.  

“Mohammed was back home just three days after the surgery and he's doing great. Of course, his health is the most important, but as parents you worry about everything. With this surgery we're really grateful that there is minimal scarring. We are so glad we took part in this study.”

Last year, patients at Liverpool University Hospitals NHS Foundation Trust (LUHFT) became the first in Europe to be treated offered robotic-assisted surgery for head and neck cancers with Intuitive's da Vinci Single Port (SP) surgical system.

It means surgeons at Aintree University Hospital are now able to remove tumours of the throat that previously would not have been accessible through the mouth.

This is thanks to the da Vinci SP's single access port (the arm), which enables surgeons to access tumours through a single incision or natural orifice, such as through the mouth, with surgical instruments that can then work more easily in the tight space of the throat and airway.

In some cases where tumours were unable to be removed through the mouth, patients would have needed big operations to split their jaw to reach the cancer. This causes a lot of pain, a complicated hospital stay for up to two or three weeks with feeding tubes, and usually requires a tracheostomy tube for a period to ensure patients can breathe safely.

Being able to safely remove more tumours through the mouth results in better outcomes for patients, whether that be through significantly reduced lengths of stay of one to three days, no feeding or tracheostomy tubes, or even the potential to reduce the need for post-operative chemotherapy.

David Pope became one of the first NHS patients to undergo head and neck surgery with the new equipment. When the 65-year-old had an unusual feeling in his throat which didn't feel right, he made an appointment at his GP to get it checked out. Following a round of medication that didn't solve the issue, he returned and was subsequently referred to the Countess of Chester Hospital for further investigation.

David, who lives in Frodsham, said: “I wasn't in any discomfort, but just had an unusual feeling which didn't feel quite right. After tests at the Countess I was diagnosed with throat cancer at the base of my tongue, and referred to the Liverpool Head and Neck Centre.

“At first appointment in March with Mr Fleming, he told me about this new robot and that I'd be one of the first patients to have surgery with it. If it helps more patients like me to be seen and treated quickly, with fewer side effects and a faster recovery, it can only be a good thing.

Patient organisations told NICE's independent appraisal committee that faster recovery times, shorter hospital stays and quicker return to work were the biggest benefits of robotic surgery. Patients also reported experiencing less pain and reduced scarring compared with traditional surgery.