Raphael Thys
Patients having major abdominal operations should be offered the option of robotic surgery, doctors and scientists have said, after a world-first clinical trial found the procedures dramatically speed up recovery times, reduce complications and cut the risk of blood clots.
In a first-of-its-kind three-year study, experts at University College London (UCL) and the University of Sheffield discovered that patients having robot-assisted bladder cancer surgery recovered faster and returned home sooner than patients who had open surgery. The findings were presented at the American Urological Association annual meeting in New Orleans, Louisiana.
Robotic surgery reduced the chance of readmission by half (52%), and led to a 77% reduction in the prevalence of blood clots, when compared with patients who had open surgery. Researchers said the findings challenged the notion that open surgery was the “gold standard” for major operations.
“This is an important finding,” said co-chief investigator Prof James Catto, a professor of urological surgery at the University of Sheffield. “Time in hospital is reduced and recovery is faster when using this advanced surgery. We see fewer complications from the improved mobility and less time spent in bed.”
The trial ran from March 2017 to March 2020 and involved 29 surgeons at nine UK hospital trusts. A total of 338 patients with non-metastatic bladder cancer were split into two groups, with 169 patients having robot-assisted bladder removal and reconstruction, and 169 patients having open surgery.
“Previous trials of robotic surgery have focused on longer-term outcomes,” said Catto. “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.”
Researchers found that, on average, the robot-assisted group stayed eight days in hospital, compared with 10 days for the open surgery group. Re-admittance to hospital within 90 days of surgery was also reduced, they said, at 21% for the robot-assisted group and 32% for those who had open surgery.
Open surgery involves a surgeon working directly on a patient and involves large incisions in the skin and muscle, but in robot-assisted surgery, surgeons guide minimally invasive instruments remotely.
Scientists behind the study, published in the Journal of the American Medical Association, said it provides the strongest evidence so far of the patient benefit of robot-assisted surgery. They are calling on the National Institute of Clinical Excellence (Nice) to make robotic surgery available as a clinical option across the UK for all major abdominal surgeries including colorectal, gastro-intestinal and gynaecological procedures.
Prof John Kelly, a professor of uro-oncology at UCL and consultant surgeon at University College London hospitals, who was co-chief investigator, said: “In this study we wanted to establish if robot-assisted surgery, when compared to open surgery, reduced time spent in hospital, reduced readmissions, and led to better levels of fitness and quality of life; on all counts this was shown.”
The “striking” reduction in blood clots was an unexpected finding, he added, which “indicates a safe surgery with patients benefiting from far fewer complications, early mobilisation and a quicker return to normal life”.
“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. We hope that all eligible patients needing major abdominal operations can now be offered the option of having robotic surgery.”