Milestone achieved on St Andrew's robotics mission


Robotic surgery teams at St Andrew’s War Memorial Hospital are celebrating a huge milestone – 500 surgeries and the next step on their mission to make robotic surgery accessible for all patients.

500th Robotic SurgeryFast forward three years since the da Vinci Xi robot arrived at St Andrew’s and through the challenges of COVID-19, robotics has transformed treatment options and outcomes for patients across a range of specialties.

St Andrew’s Director of Gynaecology and Medical Advisory Chair, gynaecologist Dr Caron Forde, was the first to perform a procedure with the fourth-generation robot in October 2019.

“I began my journey into robotic surgery when as part of my role I was involved in supporting St Andrew’s urologists in their bid for a robot. I was very impressed by the advantages the robot provided and thought, ‘why not use this for women as well!’,” Dr Forde said.

“Hysterectomy and endometriosis surgery were the first areas to benefit, followed by pelvic floor and prolapse repairs, bladder repairs, treatment of all ovarian cysts, reversal of tubal ligation and fertility surgery,” she said.

Urological surgeon, Dr Jason Paterdis, who began using robotics 13 years ago, said robotic technology has revolutionised urology patient outcomes with minimally invasive techniques.

“In its infancy, the robot was used mainly for robotic radical prostatectomy in the treatment of localised prostate cancer. We are now using the robot for most procedures involving the kidney, ureters, bladder and prostate, mainly for the treatment of malignancy,” Dr Paterdis said.

“Robotics has greatly improved patient outcomes, particularly reducing length of stay, pain and need for blood transfusions. In the long term, it has proven functional benefits, particularly an improvement in urinary control and sexual function in patients treated for prostate cancer,” he said.

For Ear, Nose and Throat, Head and Neck Surgeon, Dr Ryan Sommerville, robotic surgery provides his patients with early-stage tonsil and tongue base cancer with an alternate treatment option.

“Robotic surgery is still early in its development in ENT, Head and Neck Surgery. Currently, the most common use is for removal of cancers of the tonsil or the base of the tongue. Often this can mean the patient is able to avoid radiotherapy and chemotherapy,” Dr Sommerville said.

“The second is as part of sleep apnoea surgical management. In appropriate patients, where large lingual tonsils reduce the amount of space at the back of the tongue, we can remove the tonsils, thereby improving the airway calibre at that level,” he said.

“As a surgeon, it means I can provide my patients with choices and after full discussions about the pros and cons, they can choose the treatment pathway they are most comfortable with.”

Dr Caron Forde echoed the remarkable benefits of robotic surgery for the patients she treats.

“Every part of the surgery is improved so the patients have safer surgery with faster recovery. For the individual women, it allows a great choice of options when it comes to managing her specific problems,” Dr Forde said.

“In a practical sense, this means women can be back at work within a week or two of their hysterectomy. Women with endometriosis have less disruption of their healthy pelvic tissues, so there is less long-term scarring, with better outcomes, and reduced long-term symptoms. Women with prolapses and incontinence have surgical options so their repair can be tailor-made,” she said.

For all the specialists, the future of robotic surgery is looking even better.

“Robotics is the way of the future. Surgery and surgical techniques have always evolved. Open surgery worked very well but laparoscopic, or keyhole surgery, was a marked improvement and now most surgery is minimally invasive. Robotics is the next step in the process,” Dr Forde said.

“As robotic surgery in ENT develops, it will improve access to many areas in the head and neck that are currently very difficult to access. I would like to think with the combination of 3D high-resolution visualisation that can see around corners, multiple operative arms, smaller and smaller instruments, and incorporation of other operative technologies, in the future we will see robotics used in other areas such as the skull base, deep neck spaces and sinuses,” Dr Sommerville said.

“I think robotics is heading to single incision surgery, with more flexible instruments and blending of radiological and anatomical anatomy. I also hope to see ‘tele-robotics’ performed in major centres for rural patients, whilst they stay in their home towns. Watch this space!,” Dr Paterdis said.

Robotic surgery is available to St Andrew’s patients across a range of specialities, including urology, gynaecology, ear nose and throat, and colorectal, with more to come.