Dr Jane Wilcock is a retired GP. She has more than 35 years of practice experience and shares her thoughts in a regular health column.
In my last medical article, I wrote about the enormous advances in artificial intelligence (AI) and its use in robots, detailing the benefits and risks to humanity as I see them.
In medicine, laparoscopic robotic-assisted surgery (RAS) is becoming routine, and the use of AI in various functions is being investigated.
This article aims to bring you up to speed with current advances in this area.
There are generally three types of surgery.
First is traditional open surgery, in which a surgeon gains good access through a large incision and stands, sometimes for hours, over the operating table and patient.
The second is laparoscopic surgery, in which small cuts are made, and a tube with a light and lens inserted, and then instruments are inserted through other cuts, so that surgery occurs through small cuts and reduces the risks of infection and muscle weakness postoperatively.
The third is RAS. Newer RAS is currently being evaluated but has been part of routine care since 2018 for a couple of procedures in the UK, where the patient has agreed and is technically suitable.
RAS uses a high-resolution camera with 3D images and more variety of angles to check surgical positioning.
The surgeon sits at a console and uses their hands to control the instruments, allowing more precise movements. It likely helps surgeons as they age, as traditionally they are bent over patients for hours, looking into the operative cuts.
Having high-power magnification also helps.
A systematic review back in 2018 by Yuefeng Du confirmed these advantages.
NHS England recommended that RAS is offered to any man with localised prostate cancer (cancer that has not spread) requiring radical prostatectomy surgery.
It is more costly as there are training and equipment needs, but it is less invasive and reduces the risk of urinary incontinence and sexual problems postoperatively.
Men have reduced blood loss and reduced hospital stays.
It makes no difference to long-term cancer outcomes compared to other surgeries.
In 2018, HealthTech guidance, HTG 468, Robot-assisted kidney transplant, was published, ensuring that surgeons undertaking this were trained and results published to prove benefit or harm compared to previous surgical methods.
RAS results in shorter hospital stays, reduced blood loss, fewer infections, less pain and better appearance of scars compared to open surgery.
As there is less muscle cut through, there is less weakness and postoperative hernias.
The procedure is the same as above; the surgeon works from a console controlling the small instruments placed into the abdomen by small cuts.
In the US, open transplants are still the procedure of choice, but RAS is becoming more common.
It is thought that 15 per cent of all surgeries in the US are RAS; over there, it may be used in hysterectomy, endometriosis, fibroid removal, gallbladder removal, appendix removal, knee and hip replacements, heart valve repairs, and complicated hernia repairs.
In Europe and the UK, it is about two per cent of all surgeries.
Worldwide, it has also been used for epilepsy treatment and throat and ear surgery.
Our National Institute for Health and Care Excellence (NICE) publishes HealthTech guides (HTG) in which evidence for the RAS is generated over three years, and the RAS company then submit the evidence to NICE for assessment.
Information needed is about cost, resources, training, outcomes of surgery, long-term outcomes and experiences of the patient.
HTG 742 in 2025, Robotic surgery for soft tissue procedures: early value assessment, is exploring outcomes for five RAS companies.
It is hoped that it will increase access to soft tissue surgery for more groups of people. These are lumps and bumps on the skin, hernias, and head and neck surgery.
There is evidence that the shorter time for patients to recover and have the procedure will reduce waiting lists.
Although costly to set up, it is hoped that reduced complications will mean it is cost-effective long-term.
HTG 743 2025 robot-assisted surgery for orthopaedic procedures: early value assessment has been set up for evidence generation of six RAS systems.
If successful, it may become mainstream throughout the UK. The key benefit is that instead of the surgeon making an assessment of the implant position, the RAS can make the position of the new joint implant more precise.
It has no evidence yet, but it is hoped that this will improve recovery time. It will also make implants more compatible to other ethnic groups.
There is evidence that some Asian groups have a different skeletal shape than Caucasians, which can cause implant positioning challenges.
Evidence will be collected on whether patients find outcomes better with RAS.
Some of these systems do not need preoperative scans, which again reduces wait and cost.
In other areas of health care, AI has been successful in retinal screening, identifying people needing urgent therapy with high rates of accuracy.
The NHS Long-term Plan aims to use AI to help interpret scans. It is also used in skin analytics to identify skin cancers and is used in NHS 111 to help triage people calling in worried if their health need is urgent.
In another area, AI is used in a robot to navigate around some hospital areas and deep clean them, using UV waves (when people are not present).
This will become more common in areas where wards are shut due to infection.
From this, we can envisage a greater use of AI in assisting clinicians to improve health through accurate diagnoses and minimal interference surgery.
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