Guy's and St Thomas' has pioneered the use of robotic technology in the UK. We are now an advanced training centre and are internationally renowned for our robotic-assisted urological surgery.
What is robotic-assisted surgery?
See our laparoscopic and robotic procedures page for information on what robotic-assisted surgery is, its advantages over other types of surgery and the procedures we perform.
Meet the expert: robotic surgery – video transcript
I'm Ben Challacombe, I'm one of the consultant urologists at Guy's and I'm also one of the robotic surgeons.
So the robotic surgery programme at Guy's and St Thomas' has been going now for 13 years, it's the longest programme in the UK, almost 3,000 patients have been treated with robotic surgery here.
We treat mainly prostate cancer in terms of the highest percentage, but also have a very strong programme for both bladder and for kidney cancer, and some other rarer cancers that we see within the urological group.
So robotic surgery is really just a variation on standard laparoscopic, ie keyhole, surgery.
It uses the same small holes in the patient's skin, the same small scars, but instead of long straight instruments controlled by the individual surgeon that can kind of just go left and right and up and down, little tiny arms go in that are controlled by the surgeon but away from the patient.
These arms have actually got a higher range of motion and they're connected to a machine, called the robot, and the surgeon actually operates from a console that can be several metres away from the patient.
Robotic surgery has many patient benefits, really from the point of view of the minimally invasive aspects of the surgery, so obvious things such as quicker recovery, smaller scars, less blood loss, less pain, earlier return to work and less stay in hospital.
But also we think that there are some aspects of the operations that we can actually do much better with a robotic approach than either a laparoscopic, and occasionally also than a traditional open approach, because really of the the dexterity of the robot and the precision and the three-dimensional vision that it gives you.
So we really have all of the technology at our fingertips to provide the best treatment for our patients.
The da Vinci robotic system
We installed a da Vinci robot in 2004 thanks to a grant from Guy's and St Thomas' Charity. From the success of our robotic surgery programme and the increase in demand from patients, in January 2011 we upgraded to the latest model. This is the Da Vinci Si HD dual console system, featuring 4 robotic arms and a double operating console. This advanced robot allows surgeons to:
- control instruments while sitting at a special console away from the patient's side
- view details extremely closely (at up to ten times the magnification) and at a high resolution because of its unique 3 dimensional (3D) vision system
- move instruments in many different directions (degrees of freedom), due to EndowristTM technology. This improves the surgeon's dexterity and makes the surgery and in particular suturing, much easier compared to laparoscopic surgery.
The new robot has 4 arms rather than the previous model's 3 arms and allows 2 surgeons to operate at the same time (dual console). Its longer arms allow surgery on larger patients and means we can offer a wider range of surgery. It has a larger range of specialist instruments, including 8 and 5mm tools, is lighter and more manoeuvrable. MRI and CT images can also be shown to the surgeon while operating, while enhanced HD vision helps the surgeon as it effectively doubles the resolution.
Because the surgeon is seated in a comfortable position, it has been claimed that robotic-assisted surgery is more ergonomic (user-friendly). We are investigating this in our 'motion laboratory' as part of our research into surgical fatigue (tiredness).
The da Vinci robot is also regularly used by the gynaecology team and the ear, nose and throat and maxillofacial departments are currently developing their programmes.
Read more about the da Vinci robot on the Intuitive surgical website.
Staff involved in robotic-assisted surgery
We are proud to have one of a small number of UK urology professors in our department, Professor Prokar Dasgupta, who developed our entire robotic programme. Robotic-assisted surgery has become a standard approach in our department and as well as Professor Dasgupta, it is currently carried out by:
Many of the team are involved in robotic mentoring and training in other centres as well as teaching our own senior urology fellows and specialist registrars.
Future directions and research
We are working closely with mechanical and robotic engineering colleagues in the Academic Health Sciences Centre to improve patient outcomes after robotic surgery. We are exploring:
- MRI based pre-operative planning (planning before surgery) and intra-operative direction (during the operation), allowing the surgeon to switch between the real view and the MRI scan during the operation to help identify structures quickly and precisely.
- enhanced sensation for the surgeon via a keyhole (laparoscopic) device to scan tissues during the operation. This gives valuable and immediate information to the surgeon to improve cancer localisation.