Robot-assisted surgery can cut blood clot risk and speed recovery

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Patients undergoing major abdominal operations should be given the choice of robotic surgery, according to doctors and scientists, after a world-first clinical trial indicated the treatments significantly shortened recovery periods and reduced complications and the danger of blood clots.

Experts at University College London (UCL) and the University of Sheffield discovered that patients who had robot-assisted bladder cancer surgery recovered faster and returned home sooner than patients who had open surgery in groundbreaking three-year research. The findings were presented at the annual meeting of the American Urological Association in New Orleans, Louisiana.

When compared to patients who had open surgery, robotic surgery cut the risk of readmission by half (52%) and reduced the occurrence of blood clots by 77%. The findings, according to the researchers, call into question the concept that open surgery is the "gold standard" for large surgeries.

“This is an important finding,” said co-chief investigator Prof James Catto, a professor of urological surgery at the University of Sheffield. “Time in hospital is reduced and recovery is faster when using this advanced surgery. We see fewer complications from the improved mobility and less time spent in bed.”

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The trial, which lasted from March 2017 to March 2020, included 29 surgeons from nine UK hospital trusts. A total of 338 patients with non-metastatic bladder cancer were divided into two groups: those who had robot-assisted bladder ectomy and reconstruction and those who had open surgery.

“Previous trials of robotic surgery have focused on longer-term outcomes,” said Catto. “They have shown similar cancer cure rates and similar levels of long-term recovery after surgery. None have looked at differences in the immediate days and weeks after surgery.”

The researchers discovered that the robot-assisted group stayed in the hospital for an average of eight days, compared to ten days for the open surgery group. According to the researchers, re-admission to the hospital within 90 days of surgery was reduced by 21% in the robot-assisted group and 32% in the open surgery group.

Open surgery involves a surgeon operating directly on a patient with extensive incisions in the skin and muscle, whereas robot-assisted surgery uses surgeons remotely guiding minimally invasive devices.

Pros of robot-assisted surgery 

According to the researchers behind the study, which was published in the Journal of the American Medical Association, the study provides the greatest evidence yet of the patient benefit of robot-assisted surgery. They are urging the National Institute of Clinical Excellence (NICE) to include robotic surgery as a clinical option for all major abdominal surgeries, including colorectal, gastrointestinal, and gynecological procedures, across the UK.

Prof. John Kelly, a professor of uro-oncology at UCL and consultant surgeon at University College London hospitals, who was co-chief investigator, said, “In this study, we wanted to establish if robot-assisted surgery when compared to open surgery, reduced time spent in hospital, reduced readmissions, and led to better levels of fitness and quality of life; on all counts, this was shown.”

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He said that the "surprising" reduction in blood clots was an unexpected finding that "indicates a safe surgery with patients benefiting from far fewer problems, early mobilization, and a speedier return to normal life."

“In light of the positive findings, the perception of open surgery as the gold standard for major surgeries is now being challenged for the first time. We hope that all eligible patients needing major abdominal operations can now be offered the option of having robotic surgery.”