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State-of-the-art robotic system offers huge boost to cancer patients

Medical staff examining some new robotic equipment

A new state-of-the-art surgical robot at Morriston Hospital is expected to significantly reduce waiting times for prostate cancer patients.

Once the new cutting-edge kit is fully bedded in, selected bladder and kidney cancer patients will also be treated using the robotic system.

Only the second of its kind in Wales, it uses four arms, controlled by a surgeon using a separate console, to carry out surgery to a degree of precision far exceeding human capabilities.

Manufactured by a company called Intuitive, the da Vinci Xi robotic-assisted surgical system, to give its full name, is so dextrous it can peel the skin off a grape and stitch it back on again.

A large piece of robotic equipment in an operating theatre

Pictured right: The robotic system's patient cart and below, staff getting familiar with the Da Vinci Robotic System during a training day 

The system consists of three elements. The first is a patient cart, effectively the ‘business end’ and includes the arms, which hold a highly sophisticated camera and an array of surgical instruments.

The second is the surgeon console, through which surgeons control the instruments while viewing the patient's anatomy on a high definition screen. 

Finally there is a vision cart, which includes a high-definition screen that shows a live feed of the procedure, visible to everyone in the operating theatre and is the system’s ‘nerve centre’.

It cost around £1.6 million at a time of unprecedented pressures on NHS budgets.

But it will have an immediate impact by tripling the operational capacity for robotic procedures, reducing cancer waiting times for patients in Swansea Bay and Hywel Dda health boards.

Once fully operational, besides being extended to bladder and kidney surgeries, other suitable Swansea Bay services will also receive training and access to the system in the longer term.

Medical staff in an operating theatre

Previously, Swansea Bay booked time slots to use Wales’ first robotic system at Cardiff’s University Hospital of Wales. Now the money spent on that is helping to pay for Morriston’s own.

While using Cardiff’s system has been a big positive with procedures being less invasive and less likely to involve complications, it has been far from ideal for patients.

They have had to travel to the capital while their loved ones have often had to book overnight accommodation due to the travel involved.

Surgeons and theatre staff from Swansea have also had to spend time travelling along the M4. Now, having a robotic system at Morriston will do away with all that wasted time.

Swansea Bay urology consultant Matthew Jeffries said: “We are so pleased to have the Da Vinci robot in Swansea Bay.

“Learning to use it is like acquiring a new skill, but it’s very user-friendly, and the support and training offered by the company are excellent.

“The robotic system is very precise and excellent for operating in tight spaces, such as the pelvis. The instruments have far more movement than the human wrist, which is essential for suturing and operating near vital structures.

“The procedures are done through smaller incisions, allowing patients to recover more quickly and have shorter hospital stays.

“We’ve used the Da Vinci robot in Cardiff for nearly 10 years, sharing the system with surgeons from Cardiff and Newport.

“We’ve been operating on patients who live as far away as Aberystwyth because we’ve covered the Hywel Dda area for these procedures for some time.

“So I think to have a robot in Swansea is absolutely huge for the communities we serve.

“The other benefit involves capacity. As eligibility for robotic surgery has expanded with expertise, the robot in Cardiff has become saturated. 

“Having our own will significantly increase the number of cases we can perform, reducing the times patients have to wait for surgery.”

The robotic system’s arrival is the culmination of a huge amount of work by procurement and management teams, theatre and sterilisation teams and consultants.

For the initial months, urology will be the only specialty to use the robot but then it will support multiple specialties to develop their skills and design how to start introducing robotic procedures into their services.

Robotic equipment used by a surgeon in an operating theatre

Pictured: The surgeon console, complete with viewing scope

This is a huge step forward in the delivery of surgical services in Swansea Bay. And as the robot has a dual console, it will boost training too.

“We’ll be able to expand the service we offer beyond prostate cancer operations. We’ll be able to carry out both bladder and kidney cancer operations on selected patients,” said Mr Jeffries. 

"As well as the support and training provided by the manufacturer, one of the two surgeon consoles has a simulator. This is where the basics are learned, and with the latest technology, whole operations can now be performed on the simulator before operating on patients.”

Mr Jeffries said the dual console meant the trainee and surgeon could sit next to each other. With the flick of a button they can alternate so either one can have full control of the robotic instruments.

“This makes learning so much easier than relying on ‘feel’ or poor views down a dark hole with the previous open approach,” he added.

Swansea Bay’s urology team is also benefiting from the creation of a new post which will not only be key to supporting robotic surgery but also help support patients right through their journey.

Kelly Crowe has taken up the post of surgical care practitioner, with the role funded for the first two years by Prostate Cymru. The charity also funded training for surgeons on Cardiff’s robot, so this is part of an ongoing commitment.

Kelly will play a vital role in assisting the surgeon during the operation.  She will also be pivotal in supporting the patient throughout their cancer pathway, from pre-op assessment to discharge and follow-up. 

“It is really fantastic that Prostate Cymru has supported us in bringing in Kelly for a really crucial part of the procedure,” said Mr Jeffries.

“We are very proud of our strong links with Prostate Cymru. The health board will take over the funding of Kelly’s role after the initial two years and in the meantime we are excited about the opportunity to work even more closely together.

“Without Kelly’s role, you would need two consultants taking part in procedures so Prostate Cymru’s support and Kelly’s involvement is really crucial for us.”

Kelly has worked for the health board, in a wide variety of roles covering all specialties, since 2001.

Medical staff examining some new robotic equipment

“You fit your role around what the service needs but currently I’m focused on theatre work and the robot as it’s something we need to get up and running,” she said.

“It is amazing – it is able to articulate in such a small space. The robot’s instruments are so tiny, which helps to reduce nerve damage, for example.

“It is a bit weird to have the surgeon with their back to you, looking down a scope. There’s been a lot to get my head around.

“I wanted to join urology and robotics because as a service, urology is ahead of the game in the use of robotics. It is a huge opportunity to be able to instigate something and be part of it from scratch.

“The robot does make my job easier and it’s far better for the patients. Infections rates are lower and less recovery time is needed in hospital. It’s very good.”

Prostate Cymru Chairman and urology consultant Andy Thomas said: “We are thrilled to provide funding for the new SCP role at Swansea Bay, which we believe will make a significant difference in the lives of men battling prostate cancer. 

“Our aim is to support initiatives that directly impact patient care and improve outcomes. By investing in this crucial position, we hope to enhance the support available to men throughout their prostate cancer journey. 

“After previously funding the training of the surgeons on the first robot, we are pleased to continue supporting the Urology Department with the SCP role and look forward to Kelly helping streamline the surgical process, provide invaluable support to patients, and ultimately make a positive impact on their overall experience and recovery.



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