Surgical Robots
BCPC System Lead: Dr. Jonathan Odum (RWT), Project Manager: Kelly Hayward (BCPC)
Robotic Assisted Surgery (RAS) is fast becoming the preferred mode of surgery nationally due to enhanced surgical precision, improved patient recovery and reduced hospital stays.
Against this context a review of surgical robotic capacity across the Black Country (and wider region) was conducted in the summer of 2022, highlighting that only The Royal Wolverhampton Trust (RWT) was providing robotic surgery within the system. The review also confirmed:
- Inequitable capacity for RAS across the four provider Trusts, resulting in growing waiting lists, increased risk of patient harm and poorer (cancer) health outcomes.
- Inequitable patient access to the latest technological advancements in surgical techniques.
- Workforce challenges due to a deficit in the number of surgeons trained in robotic techniques, leaving the service vulnerable from a sustainability perspective.
The BCPC sought to ‘level up’ surgical robotic capacity across the region to address the disparity, better manage demand, and future proof services for the Black Country.
Following the analysis of activity and demand, it was determined that the acquisition of two additional Da Vinci surgical robots would bridge the inequality; one to be located at Dudley Group Foundation Trust (DGFT) and one at Sandwell and West Birmingham Trust (SWBH), with a view to developing ‘Centres of Excellence’ in renal, pelvic, colorectal, and gynaecological surgery.
Robotic surgery for these specialties will not be available at WHT due to numbers being too small to justify procurement of a robot and it is the aim to implement referral pathways between all Trusts.
A business case was developed and navigated several ‘gateways’ before the BCPC Board approved a commitment to purchase two Da Vinci Dual Console Xi Robots (a capital commitment of £2.4m with an annual revenue commitment of c. £1.5m across the two providers) in September 2022.
To support mobilisation and implementation, a system-wide Surgical Robotics Mobilisation and Implementation Group (SRMIG) was established in November 2022 to drive and deliver the Black Country Robotics programme of work under the leadership of BCPC CMO.
The SRMIG had representatives from all four acute providers including clinical leads and operational leads for General Surgery, Urology and Gynaecology, and was supported by a BCPC PMO Project Manager, to:
- Continue progression against the robotic delivery and implementation plan.
- Level up availability of robotic care across the system.
- Ensure a new model of working was developed through the concept of ‘centres of excellence’.
- Support delivery of GIRFT recommended pathways.
The SRMIG was successful in navigating all appropriate governance and procurement processes, with the first surgical robot delivered to Russells Hall Hospital on 27th February 2023 and the second robot was delivered to Sandwell Hospital on 20th March 2023.
In parallel to delivery, training has commenced for colorectal, urology and gynaecology surgeons and staff, and robotic surgery has commenced at both sites with the following number of successful surgeries performed:
Table: Robotic surgery activity by site since commencement
| Colorectal | Gynaecology | Urology | Totals | |
|---|---|---|---|---|
| DGFT | 8 | N/A | 21 | 29 |
| SWBH | 20 | 18 | N/A | 38 |
Looking Ahead
In 2023-24, as we transition into the delivery phase of this initiative, the next twelve months will see the Black Country Surgical Robotics Programme (SRP) focus on:
- Consolidating individual site experience and familiarisation of using surgical robots.
- A comprehensive (and gradual) programme of training for surgeons and clinical staff to be pursued and completed. This will/may be open to all appropriate surgical colleagues from across the four partners, subject to meeting key agreed criteria.
- The continued development of robust governance plans to deliver the new models of working.
- Produce the service specification for each ‘Centre of Excellence’.
- Implement robotic surgery referral pathways between Trusts.
- Compliance with NHSE assurance process for service change.