In the operating theater of Glasgow’s Royal Infirmary, gynecological oncologist Dr. Kevin Burton directs a four-armed robot affectionately named “Roxy.” The robot’s mechanical arms, equipped with surgical tools, are inserted through small incisions in the patient’s abdomen. Dr. Burton moves to a console resembling an arcade game, sits down, and peers through a viewfinder. Using a joystick and foot pedals, he meticulously controls the instruments, cutting through tissue while avoiding critical nerves and blood vessels to search for potential cancerous lymph nodes in the pelvic region.
It has been over five years since robotic-assisted surgery (RAS) was first introduced at Scotland’s Golden Jubilee Hospital in Clydebank. Since then, surgeons have hailed RAS as a transformative tool in complex cancer surgeries, significantly improving patient recovery times. This week, former First Minister John Swinney emphasized that innovation and technology will be one of the three key platforms for NHS reform in Scotland. Artificial intelligence is already aiding diagnostics, and a new digital app promises to enhance patient access. But what role can robots like Roxy play in the future of healthcare?
Robotic surgery has been steadily expanding in Scotland since its introduction in Grampian in 2015. Companies like Versius, Mako, and Rosa have provided robots to health boards, assisting in thoracic, urological, and pancreatic surgeries. Recently, robots have also been deployed in orthopedic procedures. In 2021, the Scottish government invested £20 million to purchase 12 Da Vinci robots, specifically to advance cancer surgeries in areas like uterine and colorectal cancers, where open surgery rates are highest.
Surgeons say RAS is revolutionizing the ability to perform delicate and complex cancer surgeries, accelerating patient recovery. However, RAS currently accounts for just 1% of all NHS surgeries in Scotland. Further investment is costly, with each Da Vinci robot priced at around £1.7 million, plus operational expenses.
Professor Graham MacKay, clinical lead at the West of Scotland Cancer Centre and a colorectal surgeon, highlights the significant benefits RAS has brought across Scotland. Over the past three years, open surgery rates have dropped from nearly 70% to 30%, reducing hospital stays by half and lowering complication rates. Professor MacKay believes expanding this program could alleviate pressure on hospitals.
One beneficiary of RAS is 84-year-old Isabel Morrison, who underwent a hysterectomy for uterine cancer. Thanks to Roxy, she was able to return home the day after her surgery and celebrate her 60th wedding anniversary. “I called it the Tin Man and said it did a good job. I woke up and didn’t even realize my surgery was over,” she shared.
Dr. Burton emphasizes that robotic surgery offers “huge advantages” over traditional open or keyhole procedures. It enables surgeons to perform more delicate operations and reduces recovery times. He also notes that rising obesity rates are directly linked to an increase in gynecological cancers, and RAS allows surgeons to operate on patients previously deemed inoperable.
Dr. Burton believes RAS has the potential to save the NHS money. Shorter hospital stays free up beds, making more resources available during crises like winter pressures. In 2021, as pandemic backlogs grew, the government saw robots as central to NHS recovery. However, with technology advancing rapidly, ministers must decide which innovations offer the most impact at the lowest cost, especially as health board budgets face unprecedented strain.
The question remains: will Scotland’s NHS robotic surgery team welcome more Roxys? For now, the answer is still up in the air.
