Robotic surgery – is it all that it’s cracked up to be? Yes, apparently

The concept of robots taking over the world has long been the subject of many a sci-fi horror film, and it is thanks to our somewhat murky cultural associations, propagated in the media, that we link images of AI with images of, say, no less than the fall of human civilisation. However, as I discovered in two rounds of interviewing, it is the experts’ opinion that – at least in the surgical field – we have nothing to fear from the robot invasion of our healthcare system.

Dr Weston, of the Royal Liverpool and Broadgreen University Hospitals NHS Trust, performed the first operation to take place in the region incorporating a robot, rendering Weston something of an expert in the field. Likewise, Dr Macdonald, of the Liverpool Women’s NHS Foundation Trust, also has years’ worth of expertise in robotics – a specialist in the field of gynaecology, wherein robotic surgery is prevalent, he uses the technology on a regular basis.
In each interview, I was surprised to hear about the near-complete lack of resistance to being prodded by all manner of scalpel-wielding metal limbs from the patients themselves. As Dr Macdonald put it, ‘The vast majority [of patients] actually see a huge advantage to having any additional technology’ used in theatre – probably due to this technology’s strong track record. He then tells me that not only is robotic surgery safe – with some patients demanding it over laparoscopic surgery – but necessary: it allows consultants to access more obscure parts with greater precision while the operation is underway. Robotic surgery is widely favoured because it produces results for both the sick, the clinician and the hospital alike; according to Dr Weston, procedures involving robots are not only lower-risk, but have decreased the amount of time the patient will spend in hospital after their operation recovering. The example he gave pertained to radical prostatectomies, and held that those who had been operated on robotically spent, on average, just one day following the procedure in hospital, compared to one week’s recuperation time for those who had undergone open surgery.

But is the story of robotic surgery one of unmitigated success? ‘With any procedure, there are always risks and complications,’ Dr Weston concedes squarely, if not somewhat evasively. ‘When [a new procedure] starts out, sometimes there can be high instances of [complications]’. Dr Macdonald concurs, referring to its ‘potential for causing damage’. However, given that robotic surgery has been exclusively introduced into ‘high-volume centres’, it is pointed out that ‘the learning curve is quicker’ when things do happen to go wrong – such as a technical malfunction, or conversion to open surgery. At any rate, the training for UK-based medics is sufficiently rigorous to put many potential worries to bed: Dr Macdonald discussed an ‘intensive’ six-week training period for surgeons to participate in, before spending the next half year working on cases that increase in difficulty with time. Just as reassuringly, Forbes has published results from a study conducted by Israel-based company Mazor Robotics which suggest that, for spinal surgery, the relative risk of a complication is a significant 5.3 times higher when fluoro-guided surgeries are opted for in place of robotic guidance. In short, unless those statistics change, it won’t be any time soon that robotic surgery is ruled out on grounds of imperilling patients.

On the other hand, there are limits upon the utility of this type of surgery. Namely, the one prevailing limitation is the affordability (or lack thereof) of the technology. Although not explicitly stated by Dr Weston, it is easy to infer that this may have something to do with the global monopoly on the production of components for the robots (which, on the bright side, he feels is on the cusp of imminent change). For the meantime, robotic surgery does not in essence exist for the vast majority of the population in the developing world because of its extortionate costs; private practices, meanwhile, offer the service to those with the capital at hand to pay for it. The counter-argument is that, while robotic surgery is clearly beneficial, its implementation in third-world-nations might detract focus away from the correction of basic healthcare deficiencies which require addressing more urgently. A second, albeit less important barrier to the expansion of robotic surgery is the fixity of the robots within a hospital – they cannot be transported hither and thither, meaning patients who need robotic surgery will have to be centralised in one complex. Logistically challenging, it does not sound quite as imposing as trying to cart an incredibly large and expensive piece of equipment from Liverpool to London intact. On the flipside, a benefit of the machinery’s fixed positioning is the efficiency of repairs – as Dr Weston says, the robots are repaired ‘as they go along’, usually at night or over the weekend, without wasting time in prepping the structure itself to be moved from place to place. As to the machine itself, I was surprised to discover that the set-up time for Dr Weston did not pose any issues, and he claimed to be able to complete a robotic procedure, with a well-trained team available, in less time than other surgeons might finish an open or laparoscopic operation. On the other hand, Dr Macdonald opined that a limitation upon the utility of robotics could be organisational and stem from the set-up of the machines – the jury remains out.

On what the future holds for robotic surgery, Dr Macdonald and Dr Weston were unanimous: it must become incorporated into other specialties and procedures, as opposed to, for instance, remaining confined largely within the fields of urology and gynaecology. On this, Dr Weston emphasised the term procedures and not hospitals, stressing his point that introducing robots into smaller hospitals would entail training that was ‘less formalised’ and ‘lower-volume’ – possibly heralding unsafe operations in the theatre, further down the line. Sticking to the subject of training, Dr Weston cites his own – undertaking a fellowship – as the best kind for producing the finest surgeons who are able to work with robots (this type of hands-on programme allows trainees to undertake robotically-guided operations for a year under the supervision of a professor, and is very thorough).

Judging by both interviews, the robotic revolution in healthcare is saddled with few shortcomings. The world either seems to agree, or else simply does not care about the smattering of shortcomings that do exist. The Telegraph reported in November 2017 that in just the six years between 2014 and 2020, the market for surgical robotics is set to grow twofold, coming to total an astonishing $6bn. It’s a good job that patients in Britain have embraced the new technology to the extent that both specialists maintain – neither have encountered a patient who refused to be operated on robotically – because the practice only shows signs of expansion, not reduction.



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