A major campaign is being launched today (Thursday) to raise £2.5million for Scotland’s first robotic surgical equipment, which will be used to treat patients at Aberdeen Royal Infirmary.
The ‘Transform Today’s Surgery with Tomorrow’s Technology’ campaign is a partnership project led by North-east urological cancer charity UCAN and currently involves the urological, general surgery and gynaecological teams at ARI.
The equipment will be particularly beneficial for patients with prostate, colorectal (bowel and rectal) and gynaecological cancers and non-malignant conditions, but has the potential to be used in other specialties such as cardiac and paediatric surgery.
Considered to be the future for surgical procedures, the robot is a powerful and highly advanced tool that enables precision surgery to be carried out in many more patients, speeding up operating times.
Minimally Invasive Surgery (MIS), or keyhole surgery, has a number of advantages for patients over traditional ‘open’ surgery, including faster recovery, less pain after the operation, less blood loss and a better cosmetic result due to much smaller incisions.
The robotic equipment mimics a human hand and is controlled remotely by the surgeon, who sits a few feet away and watches greatly magnified 3D high definition video images of the operation on a screen.
This allows very delicate and complex procedures to be carried out with relative ease while still allowing minimally invasive techniques to be used.
The £2.5million fundraising target includes the cost of a theatre suite at ARI with two integrated operating theatres that will have the capacity for robotic-assisted surgery.
The conditions in the specifically designed theatres – such as the temperature, lighting and patient positioning – can be controlled by the surgeon.
Mr Sam McClinton, Consultant Urological Surgeon at Aberdeen Royal Infirmary and chairman of UCAN, said today: “Robotic-assisted surgery is the best technology currently available for minimally invasive surgery and we want to raise £2.5million by 2013 to buy this advanced equipment and the updated theatres to properly house it.
“This is the first equipment of its kind in Scotland and will help to ensure ARI can continue to provide the very best possible service for the people of the North-east, Orkney and Shetland.
“Integrated theatres allow safer treatment of patients undergoing keyhole surgery, with improved patient outcomes such as reduced hospital stay, quicker return to work and reduced complication rates.
“The introduction of a robot in the operating theatre reduces the training time for surgeons as well as being less physically demanding on the surgeon during the operation – which is particularly important when procedures take several hours. It will also increase productivity by reducing staff preparation time, theatre turnaround time and operating times.”
He added: “This is a major fundraising drive and we are calling on anyone who can support us to use this opportunity to invest in the very latest technology, which will directly benefit patients here in the North-east and set the benchmark for Scotland.”
Miss Justine Royle, Consultant Urological Surgeon at ARI, added: “Life changing complications such as incontinence and erectile dysfunction are serious quality of life issues that can result from pelvic surgery for diseases such as bladder, colon, prostate and uterine cancers. The use of keyhole and robotic-assisted surgical techniques will reduce the risk of these side effects in many surgical procedures.”
Following its success for prostate operations, robotic-assisted surgery is now used for many gynaecological procedures, including hysterectomies and common conditions such as fibroids, abnormal bleeding, pelvic floor prolapse and fallopian tube surgery as well as endometriosis.
Dr Stuart Jack, Consultant Gynaecologist at ARI said: “Endometriosis is a common condition affecting up to one in 10 women in their reproductive years. It reduces quality of life, causes pain, damages pelvic organs and is associated with infertility. Robotic surgery for severe endometriosis can help relieve pain, improve fertility and restore quality of life.”
Many bowel cancer operations can also now be done using keyhole surgery, although removing a bowel tumour using keyhole surgery is a challenging procedureand surgeons may have to switch to open surgery mid-way through the operation and make a large cut in the patient's stomach to get to the cancer.
Mr Tim McAdam, Consultant Colorectal Surgeon, added: “Robotic systems like the one we are fundraising for can make it easier for surgeons to learn to take out and remove bowel cancers using keyhole techniques, and obviously a better view and equipment reduce the chances of problems and having to make larger cuts.”
The robot will also be used in training future surgeons, as well as being used for vital research work such as further evaluation of the impact of robotic surgery.
For more information about the campaign or to make a donation, visit http://www.ucanhelp.org.uk/ or call the UCAN team on 01224 559312.
CASE STUDY:
Jim and Sandy Presly are identical twins, born in Aberdeen and brought up in the rural village of Methlick.
Aged 62, both were diagnosed with prostate cancer within a few months of each other, and underwent a radical prostatectomy as part of their treatment.
Jim (right), a retired biology teacher who is 20 minutes younger than his brother, had a traditional operation at Aberdeen Royal Infirmary, while Sandy (left) – a plant breeder who now lives in Lincolnshire – was treated at Addenbrooke’s Hospital in Cambridge using the very latest robotic equipment.
Both have made a good recovery. Here they tell their personal stories of this shared experience.
JIM
I was diagnosed with early prostate cancer in June 2010. My symptoms were not obvious, apart from a slowing down of urine flow, which was a very gradual process. The cancer was diagnosed as a result of a urinary tract infection, when my doctor decided to check my PSA levels, which can indicate prostate cancer.
When my PSA levels were found to be higher than normal, I was referred to the Urology Department at Ward 44 at Aberdeen Royal infirmary, where I had the operation to remove my prostate in October 2010.
The medical staff, surgical team, anaesthetist, nurses and ancillary staff were all great and the explanations of all the procedures were detailed and delivered with the right level of cheerfulness to keep me happy and optimistic about the outcome.
The nursing team I had were very professional, as well as a good laugh, and encouraged me to get up and going as soon as possible after the operation.
I was very lucky I had discomfort rather than pain and was able to move about very quickly, and was allowed to go home after four days which is sooner than normal, however my brother went home after just 24 hours – and my 10cm scar is much bigger than his seven tiny ones!
I started building up walking time and distances fairly soon, walking a mile in about two weeks and building up to about three miles after six weeks or so.
Having a catheter was an inconvenience, although nothing that couldn't be coped with. Its removal was a milestone, even though peeing was a bit unpredictable at first – but pelvic floor exercises work wonders. My overall recovery was a positive experience and I'm back to doing most of the things I did before, although I have still to tackle some of the really strenuous things.
Sandy’s mobility was faster than mine and he had less discomfort in doing so. His general recovery was definitely quicker - he was running a mile after less than two months. I didn't start running, gently, for three months, although it’s fair to say he’s fitter than me!
The problem I found is that you may feel so great on the outside that you start doing things before the internal wounds have properly healed.
But there are similarities between our experiences - pain getting the bowels moving after surgery and learning to pee on request rather than on demand is on the same learning curve!
On a personal level, UCAN were there from the time of being informed of the positive diagnosis, offering emotional support, practical advice and putting things in perspective.
The reassurance at the time of diagnosis was very much appreciated, and throughout the process UCAN has been great - from appearing with sanitary pads when the catheter was removed to being on hand to discuss things and what to expect.
Support wise, my brother and I have always taken an interest in each other’s health, and when I was diagnosed one of the first things I did was phone him to tell him to get checked out – which is advice I’d give to anyone who is worried.
Having gone through the process, although the treatment was different, I was able to tell him something of what to expect and how to deal with some of the issues that might arise during his treatment and recovery.
We both share the same positive attitude to prostate cancer – it’s an inconvenience that will not stop us doing what we want to do.
Caught early, this condition has very good outcomes. The cure may set you back a bit in terms of fitness, sexual function and peeing on demand but recovery happens. I'd much rather be around for longer enjoying the great things in life with my wife, our two children, granddaughters, other family and friends.
SANDY
Following Jim’s diagnosis, he contacted me in August, 2010 and I had two PSA tests the same month, and was also found to have an enlarged prostate, reduced urine flow and very high urine retention in the bladder.
A biopsy in September, under general anaesthetic, showed I too had prostate cancer, but the real benefit of this early diagnosis was that all treatment options were possible.
A radical prostatectomy was the obvious solution. Radiotherapy might have had potential long-term side effects while leaving me needing an operation to correct the poor urine flow.
Living in a small village in Lincolnshire, unlike Jim I was given the choice of how I wanted the operation performed, and where. I could have had open surgery at Hull, laparoscopy at either Sheffield or Manchester, or laparoscopy with robotics at Addenbrooke’s at Cambridge.
I opted for robotic surgery, on the basis the recovery times for any type of keyhole surgery is far faster than open. In addition, the more advanced 3D imaging available with the robot gives an added advantage to the surgeon. Another important consideration was that Addenbrooke’s have a team of surgeons who are very experienced in the use of this equipment.
Following an interview to gauge my suitability for the operation using this technique, I was admitted to hospital for my operation in January 2011.
The op lasted four and a half hours and I had no pain, other than dealing with constipation.
The morning after, I sat in a chair and after lunch I walked up and down the ward before being discharged that afternoon, just 24 hours after the operation.
It was a complete success – the prostate was removed intact along with lymph nodes and good bilateral nerve sparing, despite the surgeon having to work round a previous hernia repair done by keyhole, which could have caused complications.
I’ve got seven very small scars, which healed very quickly with no problems. Superglue is wonderful! I also had a catheter, which was removed after a week, and continue to recover well in terms of continence.
I was able to start walking quickly, building up the distance to seven miles after just 20 days.
I ran a mile 44 days after the operation, increasing to 10 miles by 66 days, so compared with Jim this rate of progress is phenomenal – although I’m a hill runner and my fitness levels were already high, which greatly contributed to my speed of recovery.
I returned to my work as a plant breeder working on oilseed rape after three and a half weeks, obviously doing no lifting or pulling but absolutely capable of doing everything else for the full day. Prior to that I was working from home after two weeks.
Early diagnosis is absolutely essential. Both Jim and I were found to have 10% of the prostate affected by cancer in the final biopsy after the operation. My initial biopsy indicated a very low level of cancer but things can happen quickly and any symptom that indicates a problem with the prostate should be investigated immediately - why live with uncertainty and worry?
Jim and I talk a lot. With identical twins what happens to one in situations like this usually happens to the other, so I was very well prepared mentally for my diagnosis when it came. We are both very pragmatic and positive so it was just a case of getting on with it.
We have signed up to two research programmes investigating prostate cancers, one at The Royal Marsden Hospital in London and the other at Addenbrooke’s Hospital.
My wife Lorna and son Ross have been absolutely great, as was my local consultant, and the cancer teams at Grimsby and Scunthorpe hospitals have been excellent. Similarly, the care and kindness shown to me at Addenbrooke’s was fantastic.
Overall I have been very fortunate in the way my cancer has been dealt with and the robotic surgery meant that I was treated quickly and made a rapid recovery – it has actually been a good experience and I cannot think of any negatives.