A recent clinical trial led by researchers at UCL and the University of Sheffield has demonstrated that robot-assisted surgery for bladder cancer removal can lead to significantly quicker patient recovery, with a 20 percent reduction in hospital stay. The study, published in JAMA and funded by The Urology Foundation and the Champniss Foundation, also revealed that robotic surgery reduced the risk of hospital readmission by 52 percent and resulted in a remarkable four-fold (77 percent) reduction in the incidence of blood clots, which are a significant cause of health deterioration and morbidity.

Unlike traditional open surgery, where the surgeon directly operates on the patient using large incisions, robot-assisted surgery allows surgeons to remotely control minimally invasive instruments through a console, aided by a 3D view. Currently, this technology is available in only a few UK hospitals.

The study findings provide compelling evidence of the benefits of robot-assisted surgery, and the researchers are now urging the National Institute of Clinical Excellence (NICE) to make this technology available as a clinical option for all major abdominal surgeries, including colorectal, gastro-intestinal, and gynecological procedures.

Co-Chief Investigator, Professor John Kelly, a Professor of Uro-Oncology at UCL’s Division of Surgery & Interventional Science, and a consultant surgeon at University College London Hospitals, emphasized the importance of these findings, stating that they provide strong evidence that robot-assisted surgery significantly reduces hospital stay, readmissions, and enhances patient fitness and quality of life. The researchers also highlighted the unexpected reduction in blood clots, suggesting that robot-assisted surgery results in fewer complications, quicker recovery, and a faster return to normal life for patients.

Professor James Catto, the other Co-Chief Investigator and Professor of Urological Surgery at the University of Sheffield, emphasized that the use of this advanced surgery reduces hospitalization time and speeds up recovery, ultimately easing the pressure on the NHS and enabling patients to return home sooner.

Trial findings

The study, conducted in nine UK hospitals, included 338 patients with non-metastatic bladder cancer who were divided into two groups: one group underwent robot-assisted radical cystectomy, and the other group had open radical cystectomy. The primary endpoint was the duration of hospital stay, and the robot-assisted group had an average stay of eight days, compared to ten days for the open surgery group, representing a 20 percent reduction. Readmission to the hospital within 90 days of surgery was also significantly lower in the robot-assisted group, at 21 percent, compared to 32 percent in the open surgery group.

The researchers evaluated 20 secondary outcomes at 90 days, six months, and 12 months post-surgery. These secondary outcomes included blood clot prevalence, wound complications, quality of life, disability, stamina, activity levels, and survival. In all secondary outcomes, robot-assisted surgery was either superior or comparable to open surgery.

Next steps

Both robot-assisted and open surgery showed similar efficacy regarding cancer recurrence and survival. The research team is conducting a health economic analysis to assess the quality-adjusted life years (QALY), considering both the quantity and quality of life.

Patient case studies highlighted the success of robot-assisted surgery, with patients experiencing quicker recovery and fewer complications.

This study serves as a significant step towards making robot-assisted surgery a standard clinical option for major abdominal surgeries, offering numerous benefits to patients and the healthcare system.