Robots ease agony of kidney cancer op

HOW ‘BIONIC SURGEON’ CUTS OUT TUMOUR IN HALF AN HOUR

TEN thousand British kidney cancer patients a year are to have their tumours removed by a robot, after health chiefs agreed that the procedure reduced the ‘almost unbearable pain’ suffered by many patients during recovery.

The £2million, multi-armed Da Vinci machine, until now licensed only for prostate surgery, is one of nine recommended procedures to have demonstrated the greatest clinical benefit and the lowest cost.

The decision is a turnaround for NHS England, which planned to decommission the robotic procedure as it costs hundreds of pounds more than conventional surgery because it uses disposable instruments.

However, clinical commissioners were persuaded by extensive evidence from the British Association of Urological Surgeons showing better outcomes for those operated on with the robot.

‘It’s great news for patients,’ said Ben Challacombe, consultant urology surgeon at Guys and St Thomas NHS Foundation Trust, who has performed 400 robotic kidney cancer operations and trained 15 surgeons in the technique.

‘This procedure allows only the cancerous part of the kidney to be taken out and is better than the traditional option, when the entire kidney often had to be removed.’

Both operations are carried out under a general anaesthetic. In conventional surgery, a 6in diagonal incision is made close to the lowest rib – a large cut that causes pain while the patient is recovering.

In robotic surgery, five tiny ½in incisions are made lower down, across the hip between the belly button and the back. Instruments attached to the Da Vinci robot arms – controlled remotely by a surgeon – are inserted through these incisions.

The kidney is loosened from surrounding tissue and the blood flow is stopped while the cancer is removed. This process takes about 30 minutes. Timing is vital, because kidney damage occurs while the organ is deprived of oxygen, and the robot operates with better vision and dexterity than is possible with conventional surgery.

‘Robot-assisted surgery allows surgeons to undertake all these steps, including suturing the kidney back after cutting out tumours, very quickly and precisely,’ said Professor Naeem Soomro, director of robotic surgery at Newcastle upon Tyne Hospitals Trust, which uses two robots for six procedures.

One beneficiary of the new technique is Barry Hartwell, of Hitchin, Hertfordshire, who was diagnosed with five kidney tumours in April last year. ‘My grandfather and mother died of kidney disease which had spread, and my elder brother had it too and had to have a kidney removed,’ says the 29-year-old plasterer. ‘But I was still shocked to be told I had kidney cancer on both sides, because at 27 you think you are invincible.’

He had the four tumours on his right side removed in May last year with open surgery, causing him ‘almost unbearable’ pain during recovery. ‘Breathing, talking, moving, coughing, all hurt so much; even now, I’m still experiencing pain on my right side. I spent seven days in hospital, several in critical care, and had to take eight weeks off work. I knew I needed to have the tumour on my left kidney removed, but I could hardly bear the thought of going through all that pain again.’

Barry was referred to Mr Challacombe to have the operation on his left side performed with a robot. ‘Compared with my first operation, my recovery was remarkable, I didn’t need to go into critical care, left hospital after three days and my pain was so much less, none at all after the first week. Within a fortnight, I was back at work.’

There were approximately 11,900 new cases of kidney cancer in the UK in 2013, a rise of 38 per cent in a decade. Half occur in the over-70s and about 4,400 patient die.

There are 60 robots in use within NHS trusts, and while in routine use for prostate surgery, many have also been used to treat lung, bladder, bowel, throat and voicebox cancer.

Urology surgeons believe bladder removal due to cancer is as pressing a case for commissioning as kidney cancer because the conventional operation is very long and often involves removing other organs.

Thoracic surgeons in Newcastle are planning a lung cancer trial after 100 robotic operations resulted in patients being able to return home one to three days after surgery, saving most of the additional cost of their surgery.