Advancing robotic surgery with Versius: pioneering dual-specialty procedures to expand access and enhance patient care.

Nearly 18 months after introducing the Cambridge-designed and developed robotic system, surgeons at Cambridge University Hospitals NHS Foundation Trust (CUH) reflect on how a multiplatform approach with Versius has enhanced the trust’s robotic surgery programme. This includes the introduction of dual-specialty, dual-surgeon robotic procedures for advanced endometriosis cases and complex mesh removal in urogynaecology, enabling more patients to benefit from robot-assisted minimal access surgery.

JW: CUH has a history rooted in research and innovation. Serving as a top UK centre for specialised care in organ transplants, cancer, brain and nerve health, children’s health, and genetics, our clinicians are often at the forefront of clinical research and advancing medical technology.

In 2023, the trust was able to upscale its robotic surgery capabilities by moving from one surgical robot to three. One of those systems was CMR Surgical’s Versius, a small, versatile and adaptable surgical robotic system used in soft tissue minimal access surgery.

We use Versius throughout the week across colorectal surgery, both for cancer cases and benign surgery, and in benign gynaecological surgery. In a UK first, we are also using it for dual-specialty robotic endometriosis excision and in complex pelvic floor surgery, with both areas intermittently requiring a dual-specialty approach.

A versatile, adaptable approach to surgery

AP: We have experience operating laparoscopically so a system that allowed us to maintain a laparoscopic-style port placement enabled a seamless transition to robotic surgery. The small, modular design of Versius’ robotic arms allows us to perform robotic procedures in all abdominal quadrants for complex colorectal disease, such as right hemicolectomy or anterior resection, with enhanced dexterity and precision. The laparoscopic philosophy applied to robotic surgery has minimised the learning curve and supported the smooth transition to totally robotic surgical procedures.

CMR Surgical’s training programme, accredited by the Royal College of Surgeons of England, facilitated this ease of transition. We trained in multiprofessional teams and learnt together as a team (surgeons and the entire surgical team in unison, including some training in our own theatres) so we were approaching this new way of operating as a collective, which further supported the transition to Versius.

IP: At CUH, we are a tertiary referral centre for urogynaecology and the management of mesh-related complications. As such, we frequently manage complex urogynaecological conditions, including advanced pelvic organ prolapse and urinary incontinence, alongside complications arising from previously inserted mesh used to treat these conditions. Our work is predominately deep in the pelvis and around the sacral promontory. The system’s small, modular arms and flexibility for port placement allow us to move efficiently in necessary abdominal quadrants.

With wristed instruments used through 5 mm ports, mimicking the principles of laparoscopic surgery, Versius offers superior suturing and enhanced angulation, particularly in confined areas such as the retropubic space or around the sacral promontory, where the close proximity of vital structures requires precision. The three-dimensional high-definition visualisation is also a significant advantage, notably in mesh removal surgery, where a fine dissection is essential to accurately identify tissues, especially operating close to vascular or visceral structures. It has enabled the entire urogynaecology team to expand the minimally invasive options available to our patients.

The laparoscopic philosophy applied to robotic surgery has minimised the learning curve and supported the smooth transition to totally robotic surgical procedures

A dual-specialty approach with Versius

AP: CUH has joined a growing list of NHS trusts using Versius for complex bowel surgery for cancer as well as for diverticular disease. Versius is particularly well suited to operating in the narrow pelvis of male patients. Moreover, we’ve become the first trust in the UK to use Versius in dual-specialty, dual-surgeon endometriosis excisional surgery, with our gynaecology and colorectal teams routinely working together in these cases.

Endometriosis predominantly affects the gynaecological organs but it can also affect the large and small bowel, which then requires dual-specialty synchronous surgery. The severity and distribution of endometriosis can vary considerably between patients so having versatility with modular arms to tailor the approach for each patient has been enormously beneficial. In addition, we are able to easily adjust the bedside unit setup if required as the operation evolves between specialties. IP: The urogynaecology team works closely with our colorectal and urology colleagues to perform mesh removal surgery using a multidisciplinary approach. One example is a total abdominal colpopexy mesh excision in a patient with vaginal mesh exposure and mesh embedding near the bowel. The case was further complicated by multiple previous surgical procedures, making access particularly challenging. A key advantage in such complex cases is the seamless transition between the surgical teams, ensuring continuity and precision throughout the procedure.

AP: The open console really facilitates dual-specialty operating as both surgeons can be sitting at the same console, have the same stereoscopic view and alternate roles as console surgeons. Equally, at the console, I can see the robot arms and the team, and I’m able to communicate with them directly without the need for microphones and loudspeakers, even when not at the bedside. It improves our communication because we’re all working cohesively as a team, even though one of us is sitting at the console. We are proud to be leading the way in this joint approach to endometriosis care, in an often underacknowledged area of women’s health.

Expanding access to robotic surgery

IP: Safe, responsible care is central to our programme and the introduction of Versius has been no exception. As a recognised referral centre, we take pride in delivering the UK’s first surgeon-led, peer-to-peer, specialty-specific Versius workshops and courses in the field of urogynaecology.

Theory sessions include plenary talks covering our experience, best practice, procedural tips and port placement strategies for specific procedures. We place a strong emphasis on hands-on and simulation-based learning. Participants progress to practical training with simulated tasks, dry box exercises and mannequin-based scenarios replicating surgical procedures so that participants can build confidence and familiarity with the system in a realistic setting. Initial workshops led by CUH surgeons have covered urogynaecology and colorectal surgery, with plans in place for further workshops in the coming months.

JW: Our Versius programme has grown much faster than anticipated. We had 60 cases projected for the first year but it surpassed triple figures in under 12 months. We routinely have it in use multiple days per week and now that more surgeons from our upper gastrointestinal teams have been trained alongside additional surgeons from existing specialties, we see this expanding to 5–6 days per week.

CUH is a large regional teaching unit, and we felt that establishing a multiplatform robotic programme and training environment was necessary to help us avoid vendor lock-in risks (increased costs, reduced flexibility and innovation stagnation) as robotics scales nationally. For us, it has been both feasible and necessary to have a variety of robotic platforms, even within specialties, so that patients can receive the benefits of tailored robot-assisted minimal access surgery depending on their treatment needs, ensuring that irrespective of platform, we are doing the best for our patients.

We are proud to be leading the way in this joint approach to endometriosis care, in an often underacknowledged area of women’s health