Hospitals and clinics

Pioneering robotic surgery techniques

Charles Evans, one of a specialist team of colorectal surgeons at King Edward VII’s Hospital, explains how sophisticated robotic equipment is leading to less-invasive surgery and improved survival rates

Charles Evans – King Edward VII's Hospital
King Edward VII's Hospital
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Firstly, what are the advantages of using robots for colorectal surgery?

At King Edward VII’s Hospital, we use the DaVinci Xi robot – the very latest robotic surgical system approved for colorectal surgery. The benefi t of this robot is that it expands surgeons’ capabilities of performing minimally invasive surgery in even the most complex of cases.

The system provides enhanced surgeon vision combined with control of articulating instruments to perform intricate movements within a combined space. Specifically the Xi robot has novel overhead architecture with slimmer robotic arms that come out from a boom, with increased instrument reach and integrated technology to address some of the limitations from earlier models. Its versatility enables a wide range of colorectal procedures to be performed, from complex surgery across the entire abdomen to meticulous dissection within the pelvis As a result, our patients are given precision, minimally invasive surgery that leads to faster recovery times and reduces the risk of complications in the post-operative period.

What sort of conditions can be treated using this kind of robotic surgery, and what impact does it have on patient outcomes?

We can perform any sort of colorectal operation in the abdomen or in the pelvis robotically, but we predominantly see the technology used for treating bowel cancer (cancer of the colon and rectum). We also use the DaVinci Xi robot to treat patients with diverticula disease, and inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease). We are also increasingly using the robot to repair abdominal wall hernias, ranging from those within the groin (inguinal and femoral) to those around stomas and complex abdominal wall defects for hernia repairs.

The robot enhances our capabilities of performing the surgery with minimal invasion, which is known to improve patient recovery, reduce length of stay within the hospital and reduce post-operative complication rates. However, in my experience, this robot has also impacted on cancer outcomes with improved quality of cancer specimens removed, which leads to potentially better long-term cancer survival and outcomes. Within my department, to date, we have had no local recurrences following rectal cancer surgery when performed with the Da Vinci Xi robot.

King Edward VII’s Hospital seems to be unique by offering patients a team of colorectal experts. What is the benefit of this?

King Edward VII’s Hospital’s colorectal robotics service is the UK’s premier clinic for robotic colorectal and general surgery. Collectively, our team have performed over 500 robotic colorectal cases, with two national trainers in  robotic colorectal surgery. We believe that it is a team approach to surgery that delivers the best results. We work closely with medical cancer and radiology experts and have an outstanding team of colorectal nurses supporting our patients along their journey.

We like to operate with two consultants present to ensure there are two pairs of experienced minds focused on the surgery and facilitating a smooth flow of the operation at all times. This spirit of collaboration continues post-operatively too. After having their surgery, our patients are checked each day by one of our consultant surgeons, so they can be assured that they are receiving outstanding clinical care. Our multidisciplinary approach means that we take collective responsibility for each patient, providing them with the best possible outcomes.

Colorectal Surgeons

How do you interact with patients before and after their stay in hospital?

At the King Edward VII’s Hospital, we offer clinics and virtual consultations to patients before surgery. All patients meet a colorectal nurse specialist before their operations, who is always there to support them through their surgical journey before and after the operation. All patients also receive a digital health app called My Recovery App. The app can be accessed at any stage in the patient’s treatment journey, so they will receive information on what will happen in the operating theatre and how they can prepare for surgery. They can also use the app to answer questions about their diet and any symptoms, and what they should be able to do at various stages of their recovery.

As clinicians, the information we receive through this app is valuable, as it provides us with crucial data, monitoring our patients outcomes objectively. Overall, it’s a brilliant way of tracking our patients, and ensuring that they feel cared for and supported long after they have left  hospital. I think it’s important to stress, however, that if patients would rather  speak to us, we are very much open to  that too. Our nurse practitioners are wonderful at putting patients at ease and discussing their symptoms, and everyone on the team is happy to do the same, either over the phone or face to face. Of course, we can’t be with the patients all day, every day, but with the app, and links we have in place, our patients feel they are getting a well-rounded service. The feedback we're getting on patient care and communication is certainly very positive.

As well as robotic surgery, what other areas of expertise do you have in your role as a colorectal surgeon?

I am also an expert in general and colorectal surgery, as are the other surgeons in my team. We all have  extensive expertise in managing hernia conditions of the abdomen and groin, including inguinal hernias, umbilical hernias and incisional hernias post previous surgery. Furthermore, we specialise in endoscopy services, including colonoscopy and sigmoidoscopy, treatments for haemorrhoids and other perianal conditions, such as fistula and abscesses. My colleague, Mr Kinross, is  an expert in the gut micro biome, and  we are all experts in diagnosing and treating conditions of the lower digestive tract, which includes the colon, the  rectum and the anus.

In terms of robotic surgery, what sort of advances can we expect to see in future?

The next few years are going to be incredibly exciting, and I believe there will be huge strides made across all areas of robotic surgery. At a basic level, I think surgeons are simply going to be able to perform a much wider range of surgical procedures robotically. The robots of the future will be smaller and more sophisticated, which, as far as colorectal surgery is concerned, means that patients will end up with fewer and smaller incisions being made. Surgery could also become smoother and less invasive due to the increased use of artificial intelligence.

We should also see a more widespread reliance on digital health in terms of assessments, imaging and visualisation. This will have an increasingly significant impact on the planning and implementation of medical procedures. However, as with the increased use of robotics, there will still be a need for experienced, well-trained surgeons that are leading these technologies. This is what we have at King Edward VII’s Hospital, and I feel incredibly proud to be part of such an incredible and forward-thinking team.

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