Danielle Collins, Consultant Colorectal Surgeon at NHS Lothian’s Western General Hospital, highlights the impact of the elective care backlog on NHS surgeons. Danielle also makes the case for how surgical robots and their data ecosystems can play a critical role in in alleviating pressure and boosting surgical capacity. 

Around five million patients in England were waiting for surgery in March this year – the highest number since modern records began. Unfortunately, the situation will get worse before it gets better, with official predictions that the backlog “could climb to 13 million patients in England” before the year is out. 

The crisis in elective care has arisen from a twofold blow of acute healthcare workforce pressures resulting from rising Covid-19 cases, and large numbers of staff still having to self-isolate across the UK, as reported by BMA Scotland.  

While cancellations and delays in surgical procedures often have negative consequences for patients, there are also significant implications for our surgical workforce – this impact often lies beneath the surface of the headline grabbing figures. Firstly, Covid-19 has decimated training opportunities for clinical staff over the past 12 months, impacting recruitment and retention of the surgical workforce across the UK at a time where maintaining staff numbers is more important than ever. 

Given the time pressures on theatre sessions, both training opportunities and adoption of new techniques have been affected. Added to this, all existing trainees have had reduced experience in outpatient clinics, ward work, and multidisciplinary meetings because of redeployment to support the emergency response to Covid-19. This disruption has been acutely felt in procedure-based specialties, such as surgery. 

There is no doubt that trainee surgeons are completely committed to supporting surge demands resulting from the pandemic, but delivery of adequate surgical training is equally important in ensuring the continued supply of these vital medical professionals. 

A further consequence of the pandemic will be the exceptional demands placed on the surgical workforce – already a major issue – as we tackle the backlog. Strikingly, in 2019, three in four UK surgeons reported experiencing back pain while performing laparoscopic surgery, according to research by CMR Surgical, while one in five surgeons in the UK and US were set to retire early due to the physical toll of conducting minimally invasive procedures.  

Both the physical and mental toll of performing surgery cannot be underestimated in the context of tackling this backlog. Surgeons cannot be overwhelmed or put at high-risk of developing work-related injuries that force them to retire early when we need them the most. 

How surgical robots can alleviate pressure in the long term 

It is vital that we support our nation’s surgeons (both trainee and experienced) with long-term investment in the right tools, training and resources, so that patients can get the long-awaited care they urgently need as quickly as possible.  

For instance, robotics can help relieve the physical and mental pressure when experienced surgeons are performing keyhole surgery, helping to prevent them from leaving the workforce due to physical work-related trauma. Historically, surgeons have been required to contort themselves and occupy static positions for prolonged periods of time in the operating room. 

And the ‘one size fits all’ limitation of traditional equipment can lead to multiple physical issues that put surgeons at risk of developing musculoskeletal disorders. Revolutionary surgical robotic technology overcomes many of these challenges by helping to alleviate some of the physical and mental impact of performing surgery and ultimately supporting surgeons’ wellbeing with the potential to extend their careers.  The use of robotics when performing minimal access surgery, for instance, allows for a more comfortable and flexible operating position. Not only that, it also provides a better view to surgeons through camera control and advanced 3D imaging. The flexibility of robotic instruments combined with optimal view can make difficult operations easier to perform. 

The Versius robot used at NHS Lothian is portable, modular, and designed to be easily moved between operating theatres and can be set up in 15 minutes. This has potential to help hospitals ease pressure on surgeons whilst at the same time boosting capacity. If these robots can be used at scale, they can increase the frequency and accessibility of minimal access surgery, thereby reducing patient waiting times and length of stay in hospital, all of which will prove critical for a long-term recovery.  

Boosting training with a digital interface 

Crucially, the adoption of surgical robots not only support surgeons ergonomically in theatres, the data sets and simulation they provide can also help fine tune the skills of future surgeons. Surgeons have the option to develop the motor and cognitive skills required for the most demanding of surgical tasks in a virtual environment with performance feedback to hone their technique. This isn’t about training surgeons how to use robotics equipment; this is about using the latest technology to help surgeons gain valuable surgical experience – something that is particularly vital in the current pandemic environment. 

Using data in this way makes personalised training that mirrors best-in-class performance a real possibility for more surgeons than ever before. This not only has the power to improve proficiency quicker but is also a way to help surgeons of all experience levels benchmark and improve their technique. 

Let us make them part of our planning  

The response from hospitals across the UK when faced with the unparalleled clinical demands and logistical challenges of Covid-19 has been outstanding. The pandemic has also underscored the need for hospitals and the medical community to prepare and plan to ensure continuous care delivery. I reflect on this in light of the compelling requirement to protect our surgical workforce both in terms of ensuring trainee surgeons receive the necessary training opportunities to qualify, and that experienced surgeons can enjoy a long injury-free career.  

Even more broadly, the use of surgical robotics makes sense clinically. I have seen the theatre staff enjoy learning new skills, while the nursing staff looking after post-op patients have commented on the speedy recovery of the patients who had a robotic procedure. Indeed, minimally invasive surgery provides many benefits to patients including smaller incisions, faster recovery times, as well as reduced pain and scarring. For these reasons, I believe surgical robots and their data ecosystem should form integral parts of our surgical workforce’s future in planning the post Covid-19 recovery.