John Addenbrooke Lecture Q and A
At the John Addenbrooke’s Lecture on 24 February 2022, there were a number of questions submitted by the audience.
The panel wasn’t able to answer them all on the evening, but they have kindly got back to us on all the questions and provided answers below:
How will robot surgery change things for surgeons?
When the robot is operating, can other surgeons be working on the patient at the same time, or is it only one person/robot at a time?
Answer: Most of the time a set of surgeons will operate in one field, the benefit of that is that they address one step before moving on. It’s very rare that we do two things or synchronously in an operation at the same time. Doing more than one step, doubles the risk to the patient
We take each operation a step at a time to ensure it is done safely, because it minimises the risk to the patient.
When we do the robotic surgery, although the surgeon will be sitting at the robot console looking down the viewfinder, the surgeon will have an assistant standing right next to the patient – changing inserts to scissors, a grasper or needles or sucking out fluid. That’s how it works in the operating theatre.
You can probably manage with one person less in the Theatre Team.
A surgeon has two arms, robotic surgery brings in four arms.
I have a kidney cancer in a very difficult place - that is next to the blood supply - will it be easier to remove with robotic surgery and would it be less risky?
Also, in the past if keyhole surgery has been started sometimes you have to resort to open surgery, will this be the case with robotic surgery?
Answer: We will usually offer robotic or traditional open surgery to a patient, but the response to robotic surgery has always been very positive when explained, and where it is possible (in some situations it may not be possible). Although it is currently cutting-edge technology it is likely it will be the normal standard of care within the next 10 years. Also, stitching on the inside is exceptionally difficult with standard keyhole surgery but with a robot it is as easy as doing it on the outside.
With any keyhole surgery (of which robotic surgery is a form), there is a chance that there will be a need to change to open surgery during the operation.
Will the one robot will be capable of performing many different types of surgery, depending on the surgeon using it?
Answer: It can’t be used in cataract surgery, but it can be used in paediatric surgery.
How does the surgeon operating the robot see into the incision because it is so small?
Answer: A telescope with a 3D camera is inserted through the tiny incisions. This allows the surgeon to see into the nooks and crannies so much better.
What are the main challenges of robotic surgery?
Answer: Getting the theatre team up to speed with the new technology.
My question is regarding future surgeons. Will they be trained in open surgical procedures as a backup? I wondered what might happen if an open procedure was required?
Answer: Surgeons training today will expect to do a fellowship in robotic surgery having mastered open surgery also so that they can use the open approach if needed.
How do you avoid moving too fast / suddenly / finger slipping etc?
Answer: Robotic arms are very natural for a surgeon to use, and they add an extra layer of precision. It has very fine finger toggles that can move in all directions as opposed to the previous way of (laparoscopy), which was like using knitting needles in effect.
The view from the robot is astounding. It allows you to avoid major vessels and takes the strain out of long complex operations. It means less tired surgeons and could lengthen the shelf life of a surgeon.
How will robot surgery change things for patients?
Does the patient always need a General Anaesthetic? Can it be done under a spinal or local anaesthesia?
Answer: Patients who have robotic surgery will usually require general anaesthesia rather than local or regional anaesthesia. This allows major surgery to be performed safely in a controlled fashion with the patient fully asleep (under general anaesthesia).
Can a robot be used in transplant surgery and heart surgery?
Answer: Robotic assisted surgery is currently not performed for transplant surgery in the UK. However, in other parts of the world, robot is used for organ harvesting, for instance, removal of part of the liver in a living donor (donor hepatectomy) for transplantation purpose.
Robot can also be used for heart surgery, but this is not a service that we provide in Addenbrooke’s given that our local heart surgical centre is in Papworth.
How will robot surgery change operating times?
Does robotic surgery reduce the operation time? If so by how much?
Answer: It won’t be about a shorter time of surgery, but it will mean less intense pressure on the surgeon. We don’t wear surgeons out before their time, standard and keyhole surgery is tiring.
Some operations are quicker as there is less need to move the position of the ‘ports’ or the patient to reach different parts of the body.
The robot also allows for fewer complications and fewer follow-ups with CT scans and blood tests.
Using robotic surgery means smaller scars, less pain, and fewer complications. In some treatments it makes a marathon journey a lot quicker and, for example, patients can move on to chemotherapy much sooner.
How much average time during surgery do we think is saved by using the Robotic Assistance?
Answer: It is not so much as time saved in the operation but using robotic surgery means smaller scars, less pain, and fewer complications. In some treatments it makes a marathon journey a lot quicker and, for example, patients can move on to chemotherapy much sooner.
It won’t be about a shorter time of surgery, but it will mean less intense pressure on the surgeon. We don’t wear surgeons out before their time, standard and keyhole surgery is tiring. The robot also allows for fewer complications and fewer follow-ups with CT scans and blood tests.
Also the current robot is working flat out for six days a week – it’s the busiest robot in the UK – and even in urology we can’t offer all patients robotic surgery because there is not enough capacity.
It also allows two teams to work on two separate operations that the patient may need one after the other, rather than treating them as separate operations. That is, it becomes one single operation for two surgical teams.
We have more patients than ever on our waiting list, and we want to give them the best treatment we can. Having more robots allows us to attract the best staff and offer them the best equipment and the patients the best treatment.