In a question and answer interview with the Marylebone Journal, Professor Prokar Dasgupta explained how robotic surgery works, how it has developed since the magazine first covered it in 2015 and where it may go next. This article brings together the highlights of the robotic surgery Q&A, with a focus on what they mean for patients considering prostate surgery.
What robotic surgery is
Robotic surgery is a form of keyhole surgery. The surgeon sits at a console and controls miniaturised instruments through a series of robotic arms, while viewing the operation on a high-definition 3D screen. The robot does not act on its own; every movement comes from the surgeon's hands. Our robotic prostatectomy page describes how this is used to treat prostate cancer.
The benefit for prostate surgery
With traditional open surgery, the surgeon made one cut long enough to reach the prostate. Patients often lost quite a lot of blood, which meant more pain and a longer hospital stay. With a robot, the operation is performed through six small holes, so there is much less trauma.
The tiny instruments give better access and allow more precise cuts. Professor Dasgupta also pointed out that even the best surgeon may have a slight tremor at the tip of an instrument, and the robot filters this out completely.
Progress since 2015
The underlying idea remains similar, but there have been real improvements. Modern 3D high-definition screens magnify the view around ten times, so that the prostate, roughly the size of a chestnut, appears as large as a football.
Image-guided surgery has also developed. Scans of the prostate can be transferred into the robot so that the best route to the tumour is planned before the operation starts. Accurate scans can even be used to 3D print a model of the prostate, showing exactly where the tumour lies and helping the surgeon remove all of the cancer.
Connectivity and artificial intelligence
Secure, low-latency communication now allows an expert surgeon to guide an operation from another part of the world. During the pandemic, an augmented reality platform called Proximie allowed a surgeon in Seattle to help guide a complex procedure in London. Our article on the UK's first long-distance robotic prostatectomy shows how far this has since progressed.
Artificial intelligence can also track a surgeon's movements across many operations and link them to how patients recover, for example with continence and erections. This helps identify which techniques lead to better outcomes.
Will robots operate on their own?
Some parts of operations can already be automated in research settings, but Professor Dasgupta stressed that fully automated surgery is a long way off. Unexpected events happen during operations, and machines can fail, so human judgement remains essential. He calls the study of what machines and humans each do best "humanics", with patient welfare as the ultimate aim.
Fitness before surgery
Asked whether robotics makes it easier to operate on people with obesity, he said that it is physically easier, but that does not mean it is the right thing to do. During robotic prostate surgery the patient is tilted with the feet above the head, which puts pressure on the heart and lungs. The fitter the patient, the better they come through it.
For a man with obesity, the risk from heart disease or diabetes may be greater than the risk from prostate cancer. Stopping smoking, cutting down on alcohol and losing excess weight all help. Our checklist for preparing for robotic prostatectomy covers this in more detail, and the NHS offers support to lose weight.
How common robotic prostate surgery has become
When Professor Dasgupta started, about 1% of prostate operations were robotic, with only two robots in the country, at Guy's and St Mary's. The London Clinic was the first private hospital to invest in the technology. According to data from the Royal College of Surgeons, around 90% of these operations are now robotic.
Our news page collects other interviews and features on his work.
To discuss robotic surgery with Professor Dasgupta, please contact the clinic.