The robotics revolution has arrived, and it is changing how we do surgery

Professor Neil Mortensen, immediate past president of the Royal College of Surgeons of England, examines the role of robotics in light of the NHS Long Term Workforce Plan.

Rather than robots becoming our rivals or doing our thinking for us as surgeons, they will – and have already – become our alter egos.

The NHS has embarked on what is described as the biggest expansion in training and workforce in its 75-year history. The new NHS Long Term Workforce Plan embraces modern technology; it highlights how robotics is transforming surgical care and could ease pressures on staff, while artificial intelligence (AI) could speed up waiting times and support diagnosis.

As the plan itself describes, some of the benefits for surgeons include improved 3D views and better access to confined spaces by increased manoeuvrability of the ‘wrist-like’ instruments. The potential for patient benefits includes smaller incisions and better cosmesis, as well as a shorter recovery time. NHS England is also collaborating with the Royal College of Surgeons of England, the accrediting surgical bodies, and the robotic industry providers to support research aimed at building a framework for a robotics surgical curriculum, which will hopefully also create a roadmap for improving the training experience.

Over more than seven decades, the NHS has been no stranger to deploying modern technologies and world-leading innovations, from kidney, heart and liver transplants to joint replacements and minimally invasive surgery. Every working day in the NHS, 47,000 patients have an episode of planned care like a surgical procedure.

Speaking to surgeons across the country, and with my own early experience with robotic surgery, I can see that robotic-assisted surgery (RAS) has allowed greater precision during operations, shorter recovery times, and better patient outcomes when used on appropriately selected patients. The RAS revolution is here and now, far removed from fictional accounts of superhuman AI running amok.

Whether it’s a Google search answering our questions or Maps navigating us to our destinations, the power of AI has now extended to healthcare and life-changing medical treatment, transcending human limitations. AI-based systems can be fed recordings of thousands of surgeries in seconds and remember each procedure with equal precision.

Robots entered the realm of medicine in the 1990s, along with a demand for minimally invasive surgery. The emergence of artificial intelligence (AI) technology has accelerated its development. It is important to emphasise that surgeons have total control of the robotic system’s movements, and that autonomous robotic surgery is a long way off.

We want to support surgeons to use technology, where appropriate, for their patients to its full potential and to keep those patients and their wellbeing at the centre of our work. Conventional surgery can be physically demanding, and some robotic platforms can reduce the fatigue surgeons endure, a considerable benefit to our profession that could prevent surgeons from sacrificing their physical health and see them extend their careers. Interestingly any hand tremor is completely eliminated by the robot and the robot’s speed can be increased or decreased when something especially delicate is being carried out.

Our new three-year strategic collaboration with Intuitive, a robotic-assisted surgery (RAS) leader, is a major step in our plan to lead the Future of Surgery. It will help strengthen RCS England’s work to review and develop the evidence base for the use of robotics and ensure future RAS training enables the best patient outcomes.

I see RAS as one of the key changes in how surgery is delivered across healthcare in the next 10 years, with uptake already increasing rapidly. Intuitive’s support will enable RCS England to strengthen the people and resources available to support a multi-professional network of experts. This independent expert group will regularly convene to drive future research into RAS, facilitate improved access to training in RAS, improve the quality of data available about RAS, and raise public, patient, and policy awareness.

On my Presidential visits up and down the country, I have heard from many surgeons about state-of-the-art robotics in action, from the 3000 robotic procedures at Portsmouth’s Queen Alexandra Hospital since the installation of Intuitive’s da Vinci system in 2013 to the robotics programme in pancreatic surgery at Royal Liverpool University Hospital. At Guys Hospital robotic prostatectomy for cancer as a day case is almost becoming routine.

Our training methods must adapt for future surgeons to be at the forefront of patient care. Since the publication of our Future of Surgery report in December 2018, RCS England’s Robotics programme has facilitated funding to drive research in surgical data science and qualitative assessment of the introduction of RAS in the NHS, two major research projects in UK universities. The College has developed dedicated robotics e-learning and incorporates robotics into its learning offer. It has accredited multiple surgical training centres providing robotic and minimally invasive surgery training and approved Senior Clinical Fellowships with a robotic training element hosted within several UK hospitals.

Today, five billion people across the globe still lack access to safe surgery,  and here there is an enormous potential impact of using robotics and AI in surgery. Regardless of where surgeons are located around the world, AI-based robotics means they can now perform surgery across distances far greater than the width of the operating room. Robots have conducted specialised surgeries that allow surgeons to stay at a safe distance and help to communicate with patients.

Over the past 50 years, the capability of technology to improve surgical care has reached a pivotal point in the digital transformation of surgical training. The mission to identify unmet surgical training needs and map them to the patient and trainee pathway led to the launch of the Future of Surgery: Technology Enhanced Surgical Training Commission, formed by the Association of Surgeons in Training (ASiT), supported by RCS England’s Robotics Group and representatives from all trainee specialty and college associations. We look forward to a future for our trainees where high-fidelity simulation on a robotic platform will allow a “rehearsal” of the next day’s procedure the night before.

As we look towards the next 75 years of the NHS, we may see robotics with more autonomous features, for example, the increased use of micro and nanorobotics combined with targeted drug delivery. While reduced cost and improved functionalities of robotics will lead to the wider adoption of robotics in both specialist and non-specialist centres across the country.

Used appropriately, robotic-assisted surgery does not pose a threat to humans. We are keeping patients and their safety at the centre of our work. For the right patients, robotic systems can provide excellent accuracy and dexterity in operations, reduce the risks of complications, shorten hospital stays, and speed up recovery.

With NHS waiting lists at a record high in England, used well, robotics may represent an opportunity to increase surgical productivity, and our exciting new collaboration with Intuitive will help us to use independent expert opinion to maximise the potential benefits RAS can bring to the way surgical services are delivered in the future.

Surgeons have total control of the robotic system’s movements. Robotic-assisted surgery is not replacing us surgeons any time soon; it is enabling us to leverage the possibilities of the technology and achieve the highest possible technical standards and, at the same time, safe surgical care for patients.