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Playing with a 2,000,000 [pounds sterling] Robot at Liverpool Heart and Chest Hospital (LHCH).

This is not an academic paper but a recall of a fantastic experience that I had at the Liverpool Heart and Chest Hospital (LHCH) on 1st August 2017. My husband Stuart and I attended a demonstration and talk on Robotic Surgery by two very enthusiastic Consultants, one Cardiac and the other Thoracic. Whilst at the Hospital we met a number of other Consultants, G.P.'s, Administration Staff, members of the public including prospective patients, plus the CEO and Chairperson of the Hospital. Those at the meeting were very friendly, and we had a relaxing and very informative evening.

After asking numerous questions such as the costs of the 100 hours training that the Consultants needed to operate the Robotic equipment the demonstrator decided that the thing to do was to let me operate the equipment. I wondered if this was just to keep me quiet. He did not have to offer twice. I must make clear that there were no patients at the end of the Robotic arms. In reality, the model of the heart and blood vessels are only 2cms long and heart valves are very small. However, when looking into the scope everything is much magnified, and in 3D.

My task was to pick up a small rubber ring from between the blood vessels with one pincer, and stretch it using a second pincer. Both pincers were then used to place the ring onto a ten pence piece. The pincers were operated using only the thumb and first finger of each hand. In addition, foot pedals aided further movement. This was achieved with no difficulty. Others did the same as me. This whole procedure fascinated all those present.

I know that Robots have been used for minimal invasive surgery for a number of years, including the Da Vinci Robot. However, the Robot that LHCH want to use is I believe the most advanced model. It will be used exclusively for Thoracic and Cardiac Surgery if the 2 million [pounds sterling] pounds can be found. This would make it the first such machine to be used in this country. This Robot performs at least twice as well as the best Surgeon. It eliminates the risk of hand tremor, and shaking and so prevents the risk of damage to adjoining blood vessels, nerves, and surrounding tissue.

In 2012 it is estimated 200,000 Robotic procedures were performed, the majority for prostate, and hysterectomies. (1) The original Da Vinci was so called partly because of Leonardo Da Vinci study of the human anatomy. This led to the design of the first known Robot in history. (2) This system allows the Surgeon to remain seated at the console operating whilst viewing a high-definition image of the inside of the patient's body. This allows the Surgeon to keep his / her eyes and hands on any one of the 4 Robotic Arms at all times. With the previous Robots a bedside assistant had to keep adjusting the camera correctly.

Also, the Surgeon had to keep looking up at a 2D video monitor.

Each of the 4 arms of the Robot only requires a 3cm incision into the chest cavity, and the 5th one 4.5cms in length is for the camera or to insert the necessary equipment required i.e. swabs, needle and thread etc. This the bedside assistant does. The Da Vinci System always requires a human operator.

LHCH believe that in the UK somebody dies of a heart disease every 6 minutes, and that lung disease affects more than 12 million people in the UK. This accounts for 20% of all deaths in the UK.

Instead of a Heart Surgeon requiring a number of ribs to be detached from the sternum, and a long scar down the front of the body resulting this is not necessary when using the Robot. The Robot allows access to the heart from the right side of the body. For a Lobectomy operation would previously require a large incision from the back around under the arm, and then to the front of the body. Using the Robotic System both can now be performed with only 4 or 5 small incisions which is much more cosmetically acceptable, and is far less invasive.

LHCH considers that this surgical Robot will allow them to at least double the number of patients receiving minimal invasive surgery whilst at the same time it is believed that their post-operative care will be considerably reduced. The shorter recovery time will allow patients to be discharged home earlier.

In addition of benefits to patient care there are also considerable cost benefits when using the Robotic System. It costs about 7,500 [pounds sterling] for a patient to stay in I.C.U., and 750 [pounds sterling] per day in the Cardiac Ward. Robotic Surgery would normally only require 24 hours in I.C.U., and just a few days in the ward. The result would be patients going home a lot sooner than previously with considerable cost benefits to the NHS, and less personal cost to the patient. Patients would be back home in days rather than weeks. Another benefit of using the Robotic System is that much older patients, who previously would be considered unsuitable for an operation because of age / physical condition, may now be considered suitable as a result of this less invasive procedure. The operating time is normally similar to previous surgical methods. However, the risk of infection is less due to the much-reduced size of the incisions.

This Robot is widely available in the USA where each machine is used up to 4 times per week approximately. However, there is no meaningful research being undertaken to show that the Robotic System is better. I asked why this was so, and was informed that it was probably because of the Medical Insurance System. Their medical insurance gives patients the option of the old or the new. As patients will always opt for the less invasive method and quicker recovery time there is not enough information to decide which is best. If LHCH has one of these Robots perhaps statistics will become available in the future.

After the lecture, and refreshments we were invited to "A Patients Journey" which showed us what a normal patients experience would be from arriving at the hospital to their day of discharge. Patients are encouraged to walk with their relatives from the ward to the outer Anaesthetic Room. We then had a look at the Recovery Room, and from a distance the I.C.U., and one of the Cardiac Wards. Not only the patients are given first class treatment but so are their relatives. The motto is "Happy patients makes for happy relatives which is shown to aid, and so shorten recovery time."

We were both very impressed by the whole experience. 2 million [pounds sterling] is a large amount to raise. However, in a few years cost savings would more than cover this sum. In addition, patient recovery would be greatly improved. It is therefore important that the money is raised for the new Robotic System.

Whilst we hope never to have to experience the need to use this facility it would be very reassuring to know that the option was available. Any offers or ideas for fund raising would be very welcome.

References

(1.) Babbage Science and technology (18 January 2012). "Surgical robots: The kindness of strangers" (https://www.economist. com/blogs/babbage/2012/01/surgical-robots). The Economist. Retrieved 21 February 2013.

(2.) "Company--Past Present Future" (http://intuitivesurgical. com/company/history/) Intuitive Surgery. Retrieved 14 January 2015.

Loreto Sime BSc (PodMed), F.Inst.Ch.P, Lic. Ac., A.I.Y.S. (Dip Reflex)
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Author:Sime, Loreto
Publication:Podiatry Review
Date:Oct 1, 2017
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