I am a British ex-pat currently living in Singapore having had Stage 3 diagnosed having a lap D&C procedure in July here in Singapore. I read with interest this article and hope maybe that we can bring this to the attention of the "powers what be" as it appears less evasive but of course, carries its own risks and obviously there is a cost issue for the NHS. But if we "the patient" can recover quicker and the robotics can reach areas that a lap cannot - wouldn't it be great if there was just one truly specialist centre in the UK that could offer such a treatment???
Less pain and loss of blood for patients allow quick recovery from surgery – freeing up beds
A ROBOT that can reach inside patients during surgery could help to ease the bed crunch affecting public hospitals, doctors say. The machine, called da Vinci, allows operations such as repairing heart valves and removing tumours to be performed without cutting muscles. This reduces pain and loss of blood, and means patients typically recover much faster – freeing up beds.
Robotic surgery has been in use in Singapore for almost a decade, but more hospitals are now starting to invest in it. Only last year, for example, Singapore General Hospital bought the latest da Vinci model from the United States – which allows two surgeons to work together on more complex surgery. Carrying out more surgery using the technology would speed up patients’ recovery times, and get them out of hospitals faster, said Dr Joseph Ng of National University Hospital (NUH).
Public hospitals are trying hard to cope with occupancy rates of around 90 per cent. Dr Ng believes strongly in the role robotics can play in coping with both growing patient expectations and the bed crunch. The sticking point is cost. Surgery done with the robot can be three times as expensive as open surgery. Dr Ng, a consultant in female cancers, claims robotics can deliver what laparoscopy, the original keyhole surgery, promised but failed to achieve. Both techniques involve performing operations through small holes, instead of gaping cuts. However, robotic surgery can do much more, as the robot’s arm is as flexible as a human hand and can bend and rotate just like a wrist and fingers. Dr Ng said it is also far more precise and easy to learn, as the machine allows surgeons to use large movements which it translates into tiny ones inside the patient’s body.
By contrast, the equipment used in keyhole surgery can only go straight, so the area to be treated has to be accessible in a direct line from the opening. As a result, doctors who know how to perform it still often prefer to use open surgery when the spot they need to get to is difficult to reach, said Dr Ng. He added that keyhole surgery “is like trying to pick up marbles with chopsticks”, whereas robotic surgery is like doing so with your hands. It takes about 100 operations for a doctor to become competent in laparoscopy, but only 20 to master robotics.
Both techniques allow patients to recover weeks faster. Their stay in hospital is three to four days shorter than if they had open surgery. If a hysterectomy is done through open surgery, the average hospital stay is six days, and it is six to eight weeks before the patient is back at work. Patients who have the operation done with robotics leave hospital within a day or two, and are back to work in about three weeks. Madam Jane Tan, 44, had her endometrial cancer removed robotically. The information technology officer said: “I was able to get down from my bed and move around two days after the operation.”
Da Vinci was approved for use in the United States in 2000 and is commonly used in the wealthier European countries. Its cost remains high because it is the only commercially available surgical robot. At least three Singapore hospitals use it. At NUH, the robot is shared by the obstetrics and gynaecology, urology and colorectal departments. Dr Ng uses it mostly on hysterectomies, where the womb is removed. The patients on whom he performs this procedure typically have cancer of the womb lining. He and his colleagues have carried out more than 100 operations with the robot since they started in 2008. More than 80 per cent of patients had their fees subsidised, including Madam Tan.
Professor London Lucien Ooi, head of surgery at Singapore General Hospital, said patients treated with robotic surgery had “smaller incisions, less blood loss, quicker recovery, shorter hospital stays and decreased post-operative pain”. He said cost prevents it being used more often, as patients pay $2,000 to $6,000 more. The hospital carries out about 10 operations a month using robotic surgery. Tan Tock Seng Hospital does about five a month, mostly to remove cancerous prostate glands in men.
How the system works
A TINY camera and surgical tools are inserted through small openings in the body.
They are located at the end of robotic arms which rotate and move back and forth like a hand on a wrist.
The surgeon sits at a console and looks at a screen which projects a three-dimensional image of what the camera sees. With the help of foot pedals and hand controllers, he manipulates the tools inside the body.
His movements are translated into tiny ones by the robot. If the surgeon makes a 1cm movement, the instrument moves just 1mm. In normal keyhole surgery, the surgeon has to move left to get the tool to go right because the instruments pivot around the opening in the body.
The robotic system, on the other hand, lets the surgeon move the controller in the direction he wants the instrument to move.