SHEFFIELD, England — Robotic surgeons are becoming more commonplace in operating rooms across the world, and a recent study shows that’s a good thing. Cancer patients who undergo surgery by robot recover faster and are half as likely to land back in hospital, British scientists conclude. Choosing the machines over open surgery also reduces the chances of having potentially deadly blood clots further down the line.
The scientists are now calling for the United Kingdom’s National Institute for Health and Care Excellence (NICE) to review its guidance which sees open surgery as the “gold standard” for complex operations.
Every year, around 10,000 people in the UK are diagnosed with bladder cancer, which is considered to be one of the most expensive types of cancer to manage. But this latest research shows that those who choose to have their bladder removed or reconstructed through surgery with robots recover sooner and with fewer complications.
“Previous trials of robotic surgery have focused on longer term outcomes. They have shown similar cancer cure rates and similar levels of long term recovery after surgery. None have looked at differences in the immediate days and weeks after surgery,” says study co-author James Catto, a professor of urological surgery at the University of Sheffield’s Department of Oncology and Metabolism, in a statement.
A medical trial involving 338 patients with bladder cancer at nine UK hospitals was carried out by the researchers. John Hammond, 75, decided to have his bladder removed by robotic surgery in August 2019 after being diagnosed with cancer and hearing about the trial. Mr. Hammond, who is retired, says he’s thrilled to be a part of medical research that can help others in the future. He even admits being surprised by the quick turnaround for recovery.
“Amazingly, I was walking the next day and progressed excellently, improving my walking each day. I was in no pain and just had to adjust to the stoma bag,” he says. “I have fully recovered from the operation and throughout I knew I was in professional hands. I was home about five days after surgery and am grateful to Professor Catto and his team that I did not have to stay in hospital for longer than necessary.”
During the trial, patients were randomly divided into two groups who either received robotic or open reconstructive surgery. Open surgery, where a surgeon works directly on a patient, involves making a large incision in the skin and muscle. With robots on the other hand, surgeons can guide “minimally invasive instruments” remotely using a console and 3D view.
Those who were seen by a robot remained in hospital for an average of eight days after the operation. The others stayed for 10, the study shows.
“This is an important finding. Time in hospital is reduced and recovery is faster when using this advanced surgery,” says Catto. “Ultimately, this will reduce bed pressures on the [health system] and allow patients to return home more quickly.”
The chances of being readmitted to hospital within 90 days were also lower for patients who had robotic surgery — 21 percent compared to 32 percent for those who had open surgery.
“In light of the positive findings, the perception of open surgery as the gold standard for major surgeries is now being challenged for the first time,” notes co-author John Kelly, a professor of uro-oncology at the University College London’s Division of Surgery & Interventional Science. “We hope that all eligible patients needing major abdominal operations can now be offered the option of having robotic surgery.”
A number of other factors were examined at 90 days, six months and 12-months after patients went under the knife, including the risk of having a blood clot and wound complications. They also reviewed patients’ quality of life, stamina and activity levels, as well as any disabilities or deaths. All were either improved by robot-assisted surgery or equal to having open surgery, the researchers found, with the prevalence of blood clots falling 77 percent.
“An unexpected finding was the striking reduction in blood clots in patients receiving robotic surgery; this indicates a safe surgery with patients benefiting from far less complications, early mobilization and a quicker return to normal life,” adds Kelly.
Around 3,000 cancer patients go under the knife to have their bladder removed or reconstructed in the UK every year.
Robots, which are only available in a small number of UK hospitals, should be an option for all major abdominal surgeries, including colorectal, gastro-intestinal, and gynecological, the researchers say. Further research is being carried out to establish the quality-adjusted life year (QALY) from using robots to perform bladder cancer operations, a measure which captures both quantity and quality of life.
The findings are published in JAMA.
South West News Service writer Tom Campbell contributed to this report.