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Research Shows That Robotic Surgery Is Safer and Improves Patient Recovery Time by 20%

Research from University College London and the University of Sheffield has shown that robotic surgery to remove and repair bladder cancer allows patients to recover much faster and spend significantly less time in hospital.

A new study has found that robotic surgery is less dangerous and has faster recovery times for patients

Robotic surgery, also known as robotic-assisted surgery, enables surgeons to perform a variety of complicated surgeries with more precision, flexibility, and control than traditional approaches allow.

Robotic surgery is often associated with minimally invasive surgery, where procedures are performed through small incisions. It is also occasionally used in certain traditional open surgical procedures.

The most common clinical robotic surgical system consists of a camera arm and mechanical arms with attached surgical instruments. The surgeon sits at a computer station next to the operating table and controls the arms. The console provides the surgeon with an enlarged, high-resolution 3D view of the surgical site.

A unique clinical study led by scientists from University College London and the University of Sheffield found that using robotic surgery to remove and repair bladder cancer allows patients to recover much faster and spend significantly (20%) less time in the hospital.

The study, published in JAMA on May 15 and funded by the Urology Foundation with a Champniss Foundation grant, also discovered that robotic surgery halved (52%) the chance of a readmission and showed a “striking” four-fold (77%) reduction in the prevalence of blood clots ( deep vein thrombi and pulmonary embolism) – a significant cause of deterioration and morbidity – compared to patients who underwent open surgery.

Patients’ endurance and quality of life also improved and their physical activity increased, as measured by daily steps recorded on a wearable smart sensor.

Unlike open surgery, where a surgeon works directly on the patient and makes large skin and muscle incisions, robotic surgery allows doctors to remotely guide less invasive instruments using a console and 3D view. It is currently offered in only a few UK hospitals.

The researchers say the results provide the strongest evidence yet of the patient benefits of robotic-assisted surgery and are now calling on the National Institute of Clinical Excellence (NICE) to make it available as a clinical option across the UK for all major abdominal surgeries, including bowel surgeries to make , gastrointestinal and gynecological.

Co-Chief Investigator, Professor John Kelly, Professor of Uro-Oncology at UCL’s Department of Surgery and Interventional Science and Consultant Surgeon at University College London Hospitals, said: “Despite the increasing availability of robotic surgery, there has been no significant clinical evaluation of the Overall benefit for patient recovery. In this study, we aimed to determine whether robotic-assisted surgery shortens hospital stays, reduces readmissions, and leads to better fitness and quality of life compared to open surgery; This has been shown in all points.

“An unexpected finding was the striking reduction in blood clots in patients undergoing robotic surgery; this indicates a safe operation, with patients benefiting from far fewer complications, early mobilization and a quicker return to normal life.”

Co-Chief Investigator Professor James Catto, Professor of Urological Surgery at the University of Sheffield’s Department of Oncology and Metabolism, said: “This is an important finding. Hospital stay will be shortened and recovery speeded up when this advanced surgery is used. Ultimately this will ease bed pressure on the NHS and allow patients to return home faster. We’re seeing fewer complications from improved mobility and less time spent in bed.

“The study also points to future trends in healthcare. Soon we may be able to monitor post-discharge recovery to find developing problems. It’s possible that tracking walking levels will highlight those who need a visit from the district nurse or perhaps a previous evaluation at the hospital.”

“Previous studies on robotic surgery have focused on longer-term outcomes. They have demonstrated similar cancer cure rates and similar levels of long-term recovery after surgery. No one looked at the differences in the immediate days and weeks after surgery.”

Open surgeries remain NICE’s “gold standard” recommendation for highly complex surgeries, although the research team hopes this may change.

Professor Kelly added: “With the positive results, the perception of open surgery as the gold standard for major surgery is now being questioned for the first time.

“We hope that all eligible patients who need major abdominal surgery can now be offered the option of robotic surgery.”

Rebecca Porta, CEO of the Urology Foundation, said, “The Urology Foundation’s mission is simple – to save lives and alleviate the suffering caused by urological cancers and diseases. We do this by investing in cutting-edge research, leading education and supporting the education of healthcare professionals to ensure fewer lives are destroyed.

“We are proud to have been at the heart of the fundamental change in the treatment and care of urology patients since our inception 27 years ago, and the results of this study will improve the treatment and care of bladder cancer patients.”

In bladder cancer, a growth of abnormal tissue known as a tumor develops in the lining of the bladder. In some cases, the tumor spreads into the bladder muscle and can lead to secondary cancer in other parts of the body. In the UK, around 10,000 people are diagnosed with bladder cancer each year and over 3,000 bladder removal and reconstruction procedures are performed. It is one of the most expensive types of cancer to treat.

test results

In nine UK hospitals, 338 patients with non-metastatic bladder cancer were randomized into two groups: 169 patients had robotic radical cystectomy (bladder removal) with intracorporeal reconstruction (the process of removing a section of bowel to create a new bladder), and 169 patients had open radical cystectomy.

The primary endpoint of the study was length of hospital stay after surgery. On average, the robot-assisted group stayed in the hospital for eight days, compared to 10 days for the open surgery group—a 20% reduction. Readmissions to hospital within 90 days of surgery were also significantly reduced – 21% in the robotic group versus 32% in the open group.

An additional 20 secondary outcomes were evaluated at 90 days, six, and 12 months after surgery. These included the prevalence of blood clots, wound complications, quality of life, disability, endurance, activity level, and survival (morbidity). All secondary outcomes were improved by robot-assisted surgery or, if not improved, almost equal to open surgery.

This study and previous studies show that both robotic and open surgery are equally effective in terms of cancer recurrence and survival.

Next Steps

The research team performs a health economic analysis to determine the quality-adjusted life-year (QALY), which accounts for the impact on both quantity and quality of life.

patient case studies

John Hammond, pensioner, 75, from Doncaster, said: “I let my symptoms go for too long and found out I had a tumor in my bladder. I was lucky enough to see Professor Catto and after being given options I decided to have the surgery which involved removing my bladder and putting in a stoma.

“I had the surgery in August 2019 and was aware that it was a robotic surgery in a study and was keen to participate. In fact, I was glad to be able to help others with this type of surgery in the future. The operation was successful and the whole team gave me tremendous support.

“Amazingly, I was able to walk the next day and made excellent progress, improving my walking every day. I had no pain and just had to get used to the ostomy bag. I made a full recovery from the surgery knowing I was in professional hands. I was home about five days after the operation and I am grateful to Professor Catto and his team that I did not have to stay in the hospital any longer than necessary.”

Frances Christensen Essendon, from Hertfordshire, said: “I was diagnosed with bladder cancer and after undergoing chemotherapy it was suggested that I have my bladder removed. Under Professor John Kelly, I underwent robotic surgery to remove my natural bladder, which was replaced with a new bladder made from the intestine. The operation was a success and I was up and walking soon after the operation. After the surgery in April, I was back to work and in the gym in mid-June. I have led a normal, active life and I am eternally grateful to Prof. Kelly and his team for their care and support.”

The trial took place from March 2017 to March 2020 and involved 29 surgeons from nine UK hospital trusts; University College London Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Guys and St Thomas’ NHS Foundation Trust, NHS Greater Glasgow and Clyde, Royal Berkshire NHS Foundation Trust, St James University Hospital Leeds, Royal Liverpool and Broadgreen University Hospitals NHS Trust , Royal Devon and Exeter NHS Trust and North Bristol NHS Trust.

Reference: “Effect of Robot-Assisted Radical Cysectomy With Intracorporeal Urinary Diversion vs. Open Radical Cysectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer” by James WF Catto, Pramit Khetrapal, Federico Ricciardi, et al., May 15 2022, JAMA.
DOI: 10.1001/jama.2022.7393

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Research Shows That Robotic Surgery Is Safer and Improves Patient Recovery Time by 20% Source link Research Shows That Robotic Surgery Is Safer and Improves Patient Recovery Time by 20%

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