Can robots like Roxy revolutionise cancer surgery?

In operating theatre D at Glasgow's Royal Infirmary, gynaecological oncologist Dr Kevin Burton is directing four arms of a robot, affectionately named Roxy.

The robot's mechanical arms, with surgical instruments attached to them, have been placed inside Dr Burton's patient through small cuts in the abdomen.

The surgeon crosses the operating theatre to a console that would look more at home in an arcade and sits down.

Dr Burton looks through a viewfinder and, with a joystick and foot pedals, he begins manipulating instruments.

He is entirely in control of the robot as he cuts through tissue, avoiding important nerves and blood vessels as he searches deep into the pelvis for potentially cancerous lymph nodes.

It is now more than five years since I first witnessed robot surgeons in action at the Golden Jubilee hospital in Clydebank.

Surgeons say the contribution of robotic assisted surgery since then cannot be overstated.

This week, First Minister John Swinney spoke at Scotland's National Robotarium to pledge that innovation and technology would be one of three key platforms for reforming the NHS.

Artificial intelligence is the latest tool to assist with diagnostics, and a new digital app is promised to improve patient access.

But what role might robots like Roxy play?

Robotic surgery has been expanding in Scotland since it was first introduced in Grampian in 2015.

Companies such as Versius, Mako and Rosa have supplied robots to health boards to assist with specialties such as thoracic, urology and pancreatic surgery.

More recently some hospitals are using robots for orthopaedics.

In 2021, the Scottish government invested £20m purchasing 12 da Vinci robots, primarily to develop cancer surgery, particularly in areas such as womb cancer or bowel cancer, the specialisms with the highest rates of open surgery.

Surgeons say robotic assisted surgery (RAS) is transforming their ability to perform delicate and complex cancer surgery - with faster recovery for patients.

But so far RAS is responsible for only around 1% of the total number of operations carried out on the NHS in Scotland and further investment would be expensive, with the cost of a da Vinci robot in the region of £1.7m plus running costs.

Prof Graham Mackay is the clinical lead for the West of Scotland Cancer Centre and also a colorectal surgeon.

He tells me that across Scotland they are seeing huge benefits from RAS.

Rates of open surgery have dropped from about 70% to 30% in the past three years and it has almost halved the length of stay in hospital for patients, who also experience fewer complications.

Prof Mackay says expanding the programme to other areas would help ease pressure on hospitals.

"There are still a number of hospitals that don't have this technology," he says.

"There are other cancer types which we're not treating yet by this and certainly from what we've seen in bowel cancer, this has really been the biggest step forward in surgical care that I've seen during my career.

"What we want is that for all cancer patients, where they can benefit from it, to be benefiting."

Isobel Morrison is one patient who has benefited from RAS.

The 84-year-old required a hysterectomy to treat womb cancer but thanks to Roxy, was able to get home the day after her surgery in time to celebrate her 60th wedding anniversary.

Isobel said: "I called him the Tin Man, and just said he'd done a good job.

"I woke up, and didn't realise I'd even had it,

"When the doctors happened to be in the ward, I said 'Excuse me, have I had my operation? And they said yes'.

"So then I got home the next day, and I felt absolutely fine."

Back in surgery and Dr Burton's operation has reached a delicate stage.

Lymph nodes are cut away, and, still inside the patient's body, they are neatly put into a bag that will be removed by theatre nurses through the vagina.

Dr Burton says the robot is "fantastic" and has "massive advantages" over traditional open or keyhole surgery.

He says: "Robotic surgery gives you a really immersed close-up view, a really steady view, and has a 3D element to the vision which allows you do really complex tasks."

He says higher obesity rates have been directly linked to an increase in gynaecological cancers and robotic assisted surgery enables surgeons to operate on patients who are so overweight that they would previously have been considered inoperable.

Dr Burton says that without doubt RAS has the potential to save money for the NHS.

"If we can get patients in hospital for less time, that frees up more beds for patients," he says.

"So when you get a winter bed crisis, for example, we have more beds, we have more doctors and more nurses to actually deliver the care needed."

In 2021, with post-pandemic backlogs mounting, the government saw robots as playing a central role in the remobilisation of the NHS.

But technology moves fast and ministers need to choose which innovations will deliver most impact for less cost, when health board budgets are under more pressure than ever.

The current plans talk of better use of data to increase productivity as well as innovations in genetic testing to better target of medications.

Digital support for mental health, dermatology and the management of long-term conditions is also planned as well as a new Scottish health and social care app.

So who can say whether more Roxies are set to join Scotland's NHS robot surgery team?