The smallest surgical robot is drastically lowering training times - can help increase the number of surgeries performed per year by tens of thousands
The robots helping NHS surgeons perform better, faster –
and for longer
Surgical robots such as Versius cut training time down
from 80 sessions to 30 minutes
By Hannah Devlin Science correspondent Wed 4 Jul 2018
06.00 EDT
Versius – the world’s smallest surgical robot – designed
by British scientists at CMR Surgical. Photograph: Cambridge Medical Robotics
It is the most exacting of surgical skills: tying a knot
deep inside a patient’s abdomen, pivoting long graspers through keyhole
incisions with no direct view of the thread.
Trainee surgeons typically require 60 to 80 hours of
practice, but in a mock-up operating theatre outside Cambridge, a non-medic
with just a few hours of experience is expertly wielding a hook-shaped needle –
in this case stitching a square of pink sponge rather than an artery or
appendix.
The feat is performed with the assistance of Versius, the
world’s smallest surgical robot, which could be used in NHS operating theatres
for the first time later this year if approved for clinical use. Versius is one
of a handful of advanced surgical robots that are predicted to transform the
way operations are performed by allowing tens or hundreds of thousands more
surgeries each year to be carried out as keyhole procedures.
“The vast majority of patients, despite all the
advantages of minimal-access surgery, are still getting open surgery, because
so few surgeons have the skills,” said Mark Slack, head of gynaecology at
Addenbrooke’s hospital, Cambridge, and co-founder of CMR Surgical, the company
behind Versius. “This could be a massive gamechanger.”
The Versius robot cuts down the time required to learn to
tie a surgical knot from more than 100 training sessions, when using
traditional manual tools, to just half an hour, according to Slack.
Surgical robots already exist but the latest models are
easier to use and take up far less space; some, such as Versius, are mobile
enough to be wheeled from theatre to theatre. Intuitive Surgical, whose
original Da Vinci robot has dominated the market since being approved in 2000,
has a new “single port” model in the pipeline, allowing surgery to be carried
out through a single incision.
“We have three instruments and a camera all going through
one point and then blossoming out inside the patient,” said Jaime Wong, senior
medical officer at Intuitive Surgical. “The fewer incisions, the lower the
likelihood of infection, the less pain.”
The medical device companies Medtronic and Verb Surgical
– a partnership between Johnson & Johnson and Google’s parent company,
Alphabet – also have surgical robots in the last phases of pre-clinical
development.
“I think that robotics is likely to expand enormously in
the next 10 years,” says Prof Derek Alderson, president of the Royal College of
Surgeons. “Already it’s become evident that you can teach people to do robotic
surgery much faster and the learning curves are much quicker than for
conventional laparoscopic [keyhole] surgery.”
‘You need to extend the life of senior surgeons, but
minimal-access surgery shortens it. RSI is a huge problem.’ Photograph:
Ekkasit919/Getty Images/iStockphoto
The benefits of keyhole surgery over open surgery are
well-established: rates of hernia are halved, the consequences of infections
are far less severe (re-admission rates of 0.2% versus 52%) and fewer
painkillers are required. However, the technical expertise required means many
patients don’t get the chance.
In the NHS, 71% of appendix surgery, 28% of colectomies,
13% of hysterectomies, 32% of lung lobectomies, and less than half of
qualifying pelvic and abdominal procedures are done through keyhole procedures.
Versius comprises three robotic limbs – each slightly
larger than a human arm, complete with shoulder, elbow and wrist joints –
mounted on bar-stool sized mobile units.
Controlled by a surgeon at a console, the limbs rise,
fall and swivel silently and smoothly. The robot is designed to carry out a
wide range of keyhole procedures, including hysterectomies, prostate removal,
ear, nose and throat surgery, and hernia repair. CMR claims the costs of using
the robot will not be significantly higher than for a conventional keyhole
procedure.
With manual laparoscopic instruments, a surgeon has to
carry out every movement through a tiny incision, pivoting their hand to the
right to move their instrument left and so on. Surgeons are often forced to
lean or stoop with arms stretched at awkward angles, meaning that repetitive
strain injury (RSI), back, knee and neck injuries are common.
By contrast, surgical robots are built ergonomically and
the surgeon’s hand movements are mirrored in the movements of the instrument.
“Retirement age for doctors has gone up to 67, it will go
up further in a year or two,” said Slack. “You need to extend the life of
senior surgeons, but minimal-access surgery shortens it. RSI is a huge
problem.”
Although described as robotic surgery, even the most
sophisticated technologies in development are largely controlled by a human
doctor. “Some patients think it’s about the robot performing the operation on
its own, which is not the reality,” said Prof Guang-Zhong Yang, director of the
Hamlyn Centre for Robotic Surgery at Imperial College London.
Automation is currently aimed at smoothing out hand
tremors or marking out “no fly zones” to prevent a surgeon touching or damaging
nearby nerves, vasculature or organs. Robotics also provides super-dexterity by
allowing magnified vision and miniaturised hand movements. In the future,
telemetry data collected from large numbers of surgeries could help identify
the most effective ways of performing a procedure and provide real-time
feedback to surgeons to improve their technique.
“We’ll see the man/machine barrier changing,” says Luke
Hares, technology director at CMR Surgical. “Eventually you’ll get to the point
where the surgeon can say ‘put a stitch in here please’. But we’re right at the
beginning of that journey.”
It has been suggested that the advent of robotic surgery
could pave the way for remote operations performed by surgeons sitting in a
mission control room in a different city or country from their patient.
However, Yang urges caution. “What you want is for robots to be integrated
seamlessly … so that they disappear into the fabric of an operating theatre,”
he said.
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