Robot-assisted surgery: ‘I heard it would be less invasive and I should recover more quickly from it’

Desmond Bolton heard that robotically assisted surgery was “the way to go”; he was told it would be “less invasive and that I should recover more quickly from it,” he says.

The 72-year-old man became the subject of the 1,000th robotically assisted surgery in the Mater hospital in Dublin last month when he had his bladder and prostate removed in his treatment for cancer.

The idea of having surgery assisted by a robot “didn’t really bother me at all”, says Bolton, and he was advised that it would give him a far quicker recovery time post-surgery.

[ Meet Rosa, the new robot being used for brain surgery in Ireland ]

Afterwards, Bolton spent a week in hospital before being discharged to return home. Had he chosen more conventional surgery, he would not have been home for maybe four weeks.

Nurse who claimed he witnessed care home worker pour water over resident loses whistleblower claim

---

Woman sues alleging she had infected wounds after breast implant removal

---

UHL is no longer starved of funds. Why is it still so far from satisfactory performance?

---

Facing into the surgery, Bolton was nervous and concerned when he was informed he would have to have surgery after completing his chemotherapy treatment.

“My oncologist told me after I had chemo that I would have to go for that surgery. I was probably a bit naive, thinking that maybe the chemo might have cleared the cancer, but it just shrank the tumour.”

After surgery, Bolton received the “good news that everything has come back clear from the laboratory”.

“I was very happy with that,” he says. The tumour “hadn’t spread and they got every bit of it. And my lymph nodes are clear, which is most important.”

Bolton’s operation at the Mater Misericordiae University Hospital was a surgical milestone, reached by 16 surgeons from across six specialities: urology, cardiothoracic, colorectal, head and neck, gynaecology and hepatobiliary.

The robotic surgical programme at the Mater was launched in 2019, when the hospital bought a Da Vinci XI surgical system robot. The surgeries have typically taken five to seven hours.

“We were very lucky that the robot, which was funded by the Mater Foundation, has allowed us to offer less invasive surgery to patients,” says Greg Nason, consultant urologist who performed the 1000th surgery.

We have now got to the stage that we’re largely using robotic surgery as our starting point because we believe that it’s a better approach for the patient

—  Greg Nason

“I think it’s a credit to the hospital and everybody involved with the programme that we have got to this many cases so quickly. Hopefully it will only grow, and hopefully we get a second robot and more and more Irish patients get access to less invasive surgery.”

Nason has performed almost 200 surgeries using robotics assistance since 2019.

“We have now got to the stage that we’re largely using robotic surgery as our starting point because we believe that it’s a better approach for the patient and for the patient to get better outcomes.”

Patients are very open to the option of robotic assistance, he says. “All the robot is, is an instrument. It’s a very expensive, very fancy instrument, but the robot doesn’t do the operation.”

These surgical assistance robots can cost about €2 million each to purchase, he says.

“It is a huge outlay but it’s the cost you are going to save on length of stay” that makes it economically viable, he says.

“From the hospital perspective, there’s the initial cost, but we’re creating more beds. So if I have a patient who is due for an open operation stay in two weeks versus robotic operation or staying seven days, I have created seven more bed days so we can get more patients in through the system.”

During the surgery at least one surgeon in the operating theatre controls the robot.

“I always say to patients: it’s like a remote-controlled car. My kids go to sleep at night, the cars don’t move,” he says.

Nason says this method is better than traditional surgery, allowing surgeons to perform a “very accurate operation, magnified up in great light”

The surgeon sits in the operating theatre at a small computer station a few feet away from the patient, operating the robot remotely. The robot is attached to the patient through six small incisions. For a urological surgery, those incisions are made on the patient’s abdomen.

A small camera is inserted to give the surgeon a view of the area they are operating on, followed by “a variety of different instruments” including graspers, scissors and needle holders.

The instruments “move intuitively”, says Nason, with the controls mirroring the real-life actions.

“The scissors cuts by closing the two blades. How that actually happens in real life is I move my two fingers close together; I open my fingers,” he says.

Nason says this method is better than traditional surgery, allowing surgeons to perform a “very accurate operation, magnified up in great light”. The technology is an improvement upon traditional surgery as “your hand can only move a certain degree, whereas these instruments can move 360 degrees”.

“We all inherently have a tremor in our hands. These instruments have no tremor,” he says.

Nason says the robot surgery is “less invasive because you don’t have one big incision, you have six small incisions”. This means a faster recovery and a reduced stay in hospital.

“Blood loss is minimal with robotic surgery because the instruments we use are very fine and can stop bleeding very quickly and will cause less trauma,” he says.

Robotically assisted surgery results in the same outcomes in cancer control, says Nason. “But it’s all the other outcomes: the length of stay, the pain relief afterwards, the return to activities, the blood loss” that make robotics surgery better.