New report on how to increase access to robotic surgery 

A new report, “Improving Access to Robotic Surgery”, published by Global Business Media, acknowledges the consensus around the benefits of robotic minimal access surgery and explores the challenges of ensuring that access is increased for patients.

Dr Jonathan Agnew, Adjunct Professor of Health Policy at the University of British Colombia’s Faculty of Medicine, and editor of the report, believes that “advances [in robotic technology] continue to define the frontier of minimally invasive surgery and will change laparoscopic surgery just as the electric light bulb did over 100 years ago”. In the opening article of the report, Agnew acknowledges that “the benefits of minimally invasive robotic surgery are clear: better clinical outcomes and access to services and, in the case of surgeons themselves, significantly improved ergonomics.” But, Agnew explains that “the outstanding challenge now is ensuring that these benefits are more widely spread, not only extending the technology to laparoscopic procedures that could benefit from surgical robotics, but also improving access to more diverse patient populations.”

Key topics that are highlighted throughout the report include: reducing barriers to access – such as ensuring cost-effectiveness for hospitals looking to invest; the need for standardised training pathways and curriculum and involving the entire surgical team as part of that learning journey; and how these developments can contribute to a better working environment for surgical teams.

Benefits not just for the patient

The benefits to patients receiving MAS rather than open surgery are well documented. In their article on surgeon ergonomics within the report, Lorenzo Rosso, Margherita Cattaneo, Ilaria Righi, Margherita Brivio, and Mario Nosotti list “smaller incision, lower postoperative pain, and typically shorter hospital stays” as typical benefits of minimal access surgery.

However, despite the many benefits of MAS for patients, they note that there is “a higher prevalence of working-related musculoskeletal injury in surgeons performing minimally invasive surgery” likely due to the long hours of operation times, poor instrument design and awkward positions and movements needed for manual laparoscopic surgery.

Surgical robotic platforms allow the surgeon to sit or stand at a remote console, where they control multiple robotic arms to perform the surgery, reducing pressure on the spine and shoulders. The article argues that “the ergonomics in robotic surgery systems provide unique features that allows surgeons to overcome, theoretically, all the disadvantages of traditional (laparoscopic or thoracoscopic) surgery, with a potential reduction of surgeon’s physical stress.”

Reducing Barriers to Access

The report highlights that one of the key barriers to hospitals adopting a surgical robotic platform is cost. Agnew argues that surgical robotic platforms are often seen as expensive and in order to prevent only wealthy hospitals and their patients benefiting, he says that hospitals should either look to “increasing the volume of services performed by RAS” to ensure that robotics remains a cost-effective solution or “[increase] the re-use of certain instruments such as needle drivers and graspers beyond the current limits of 10 cycles before replacement”.

Dr James Hamilton, Digestive and General Surgeon, also writes in the report that the perceived cost-effectiveness of robotics as a challenge to adoption: “There is always a less expensive way of performing a surgery than using robotics, and it is the main argument that stakeholders use to avoid buying a robot, and the instruments and supplies needed to perform the surgery.” However, he says that once a robotics programme is working well with high volumes of procedures, these cost challenges are overcome. “[Robotics] will become a cost-effective gold standard for a wider variety of procedures,” he writes. “Essential to achieving this transition will be systems that are portable, transportable, deliver high utilisation and fit easily into existing workflows and schedules.”

Training – Practice makes perfect

Whilst rapid advancements in surgical technology represent exciting opportunities for new treatment options for patients and great strides have been made in enabling more patients to have access to MAS, patient safety and good training practices need to be considered carefully and maintain a central focus for players in the market.

Dr Marcus Carey, Urogynaecologist & Reconstructive Pelvic Surgeon, warns “Typically, robot-assisted surgical training is fragmented across industry, hospitals, and surgical society training courses and often lacking an accredited curriculum and constituent credentialing criteria”.

Hamilton concurs and summarises that “it is necessary for surgeons, health institutions, companies and educational institutions to unite in common objectives where excellence in health is the fundamental factor for promoting new lines of development, supporting research and validating results for the protection of the patient quality of care.”

A key consideration within this topic was the role of technology and how recent advancements like the introduction of Virtual Reality (VR) headsets to training pathways can improve the learning journey. However, Carey stipulates that “VR surgical simulation alone is insufficient in producing proficient robotic surgeons” and that “VR surgical simulation [should be] combined with ‘hands on’ surgical skills acquisition”.

Another key reflection in the development of thorough and well-developed training pathways that Agnew highlights is “the need to train and educate all personnel and members of the surgical team, not just the head surgeons themselves”. He argues that successful implementation of surgical robotic platforms requires the entire surgical team be trained and supported and that training shouldn’t focus on the head surgeon in isolation.

Improving Access to Robotic Surgery was produced by Global Business Media in conjunction with CMR Surgical.