07 February 2019, Professor Prokar Dasgupta -
Fifteen years ago, surgery in urology departments across the country looked very different compared with what we see today. Back in the 90s and early 00s, urology surgery was traditional surgery. But a surgical revolution has taken place in the intervening years and it has been a boon for patients, families, and surgeons alike. This is the power of robotic surgery
There has been no one single cause of this transformation. As with anything, there have been several reasons: we've seen technology not only advance, but also become far more readily available for surgeons. What was once only available in specialist hospitals in the USA is now available throughout the UK.
To complement this advancement in technology, we've seen urology departments embracing the new technology. Urological surgeons have become trend setters and, as their success with robotic surgery has become clear, other specialities have started to replicate them.
But, underpinning this unprecedented transformation has been The Urology Foundation.
Back in 2004 I was one of the only people in the UK to perform robotic surgery. TUF started to dip their toes in the water in those early years by funding my travel around the country so that I could train new surgeons.
Since those early days, TUF's investment has expanded hugely so that now they are among the nation's leading investors. They initially funded UK training at King's College London and overseas training for urologists by sending them to work with the world's best surgeons. Then they began to fund fellowships within the UK, so that surgeons could learn from those that had travelled abroad.
Now, in 2019, TUF has 5 centres of excellence in the UK. Trainees can travel to these centres for intensive three day training courses where they are able to practice robotic surgery on cadavers.
All this means that the number of robotic surgeons in the UK has expanded dramatically and it is thanks to this investment from The Urology Foundation.
In 2012, 32% of radical prostatectomies (surgery for prostate cancer) were robotic. By 2013 that rose to 50% and by 2017 it was 86%. Meanwhile, for partial nephrectomies (surgery for kidney cancer), 36% were performed robotically in 2015. This figure nearly doubled to 61% by 2017.
It's better for patients, it's better for families, it's better for employers, it's better for surgeons, it's better for hospitals, and it's better for urology.
For the patients, surgery is a completely different experience with robotic surgery. They lose less blood, experience far less pain, and recover better than they would have done with open surgery. Instead of creating a large incision, surgeons are able to use robots to perform complex surgical procedures through the smallest of incisions.
If a patient undergoes open surgery, they can find themselves off work for several months, as well as being more prone to infection. With robotic surgery, patients often return to work within a matter of days or weeks. Inevitably, as well as being great for the wellbeing of the patient, it's also better for employers and for families.
For surgeons such as myself, the beauty of robotic surgery is that you can take part in procedures for far longer than you could with open surgery. If you are performing open surgery you will be standing up, you'll be hunched over and it won't be long before you find that you're too fatigued to reliably perform a complex operation. Robotic surgery is quite different from this.
It might look a little strange, but surgeons sit down during robotic surgery and will be engaging with an interface that operates the robot. It means that a surgeon's head will be buried in a console, allowing them to operate for far longer before they physically fatigued.
As for hospitals, they now see a much quicker turnover of patients, with a patient using bed space for far less time than they would have done with open surgery. This means that we now have hospitals that serve huge number of patients each year, which is great for waiting times.
Advanced usage of robotic surgery is also attracting the next generation of trainees to urology where they can see exciting opportunities for them to be at the forefront of what technology means for health care. Having the most enthusiastic and talented surgeons in urology is going to mean good things for the future of the specialty.
For fifteen years I have watched robotic surgery grow around me and whilst it will never be used for all types of urological surgery (it's simply not needed in some circumstances) it has had, and will continue to have, a profound impact throughout urology for some time to come.
TUF may not be the only contributors to the expansion of robotic surgery in UK urology, but it has been a catalyst for making it happen. We wouldn't be where we are today without TUF.
