The document discusses robotic surgery services in the UK. It notes there are around 50 robots currently in the UK, with most located in southern regions and private practice. The NHS funds robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted nephrectomy (RPN) procedures. It also discusses a clinical commissioning policy from NHS England that outlines criteria for funding robotic prostate cancer surgeries. Finally, it mentions that the Freeman Hospital in Newcastle was the first in the northeast to use a robotic surgery system and has now performed over 1,000 operations with robotic assistance across six surgical specialties.

1. Robotic Services in the UK
-
The Role of
Superspecialisation
Christian Bach
Consultant Urological Surgeon
Freeman Hospital, Newcastle, UK

2. European Manpower Perspective

3. Robotic Systems in the UK
• Around 50 robots in the UK (2 private) – 66 in DE
• South more than North – (Private Practice)
• NHS England funds RALP/RPN
• Further funding for RARC questionable
 No new centers to offer procedures

4. Funding of RALP

5. Clinical Commissioning
Policy: Robotic-Assisted
Surgical Procedures for
Prostate Cancer
Reference: NHS England B14/P/a
OFFICIAL
1 Executive summary
Policy Statement
NHS England will commission robotic assisted surgical techniques for the treatment
of prostate cancer (i.e., radical prostatectomies for prostate cancer) in accordance
with the criteria outlined in this document.
In creating this policy NHS England has reviewed this clinical condition and the
options for its treatment. It has considered the place of this treatment in current
clinical practice, whether scientific research has shown the treatment to be of benefit

6. Multidisciplinary Programme
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23.11.2015
Da Vinci Robot carried out 1000th operation in Newcastle
In July 2012, the Freeman Hospital in Newcastle was the first in the North East to start using the £2m robot in prostate cancer surgery. The Trust has since purchased a second
Da Vinci robot which is being used across other surgical specialities including gynaecology, ear, nose and throat, lung, colorectal and pancreatic surgery.
The robots have how carried out 1,000 operations making Freeman Hospital the only centre in the UK using robotic surgery across six surgical specialities. The extraordinary
technology has helped save hundreds of lives and, with greater precision and smaller incisions than is possible for a surgeon, dramatically reduced recovery times for patients.
1000th operation da Vinci team L-R: Emma Dickson, Sister Catherine Birnie, Sara Cross, Laura Waterworth, Professor Naeem Soomro, Paul Renforth, Rajan
Veeratterapillay and Senior Sister Maggie Birkbeck
Professor Naeem Soomro, Associate Medical Director and Consultant Urologist at Freeman Hospital, says: "We are delighted to have reached such a tremendous milestone in
such a relatively short space of time. We are now expanding this technique across other surgical specialities where we can offer robotic surgery to benefit many more patients all
the time.
“Minimally invasive surgery is certainly the way forward – it’s so much better for the patient both in terms of how we surgically treat them, and enabling them to be back on their
Newcastle Hospitals - Da Vinci Robot carried out 1000th oper... http://www.newcastle-hospitals.org.uk/news/news-item-21472...
We use cookies on this website to make your visit an easier and faster experience. If you continue to use our site, we'll assume that you are happy to receive cookies from our site. However,
you can opt out of receiving cookies. Ok, I understand
23.11.2015
Da Vinci Robot carried out 1000th operation in Newcastle
In July 2012, the Freeman Hospital in Newcastle was the first in the North East to start using the £2m robot in prostate cancer surgery. The Trust has since purchased a second
Da Vinci robot which is being used across other surgical specialities including gynaecology, ear, nose and throat, lung, colorectal and pancreatic surgery.
The robots have how carried out 1,000 operations making Freeman Hospital the only centre in the UK using robotic surgery across six surgical specialities. The extraordinary
technology has helped save hundreds of lives and, with greater precision and smaller incisions than is possible for a surgeon, dramatically reduced recovery times for patients.
1000th operation da Vinci team L-R: Emma Dickson, Sister Catherine Birnie, Sara Cross, Laura Waterworth, Professor Naeem Soomro, Paul Renforth, Rajan
Veeratterapillay and Senior Sister Maggie Birkbeck
Professor Naeem Soomro, Associate Medical Director and Consultant Urologist at Freeman Hospital, says: "We are delighted to have reached such a tremendous milestone in
such a relatively short space of time. We are now expanding this technique across other surgical specialities where we can offer robotic surgery to benefit many more patients all
the time.
“Minimally invasive surgery is certainly the way forward – it’s so much better for the patient both in terms of how we surgically treat them, and enabling them to be back on their
Newcastle Hospitals - Da Vinci Robot carried out 1000th oper... http://www.newcastle-hospitals.org.uk/news/news-item-21472...

7. N.B. FOR IN-HOUSE USE ONLY – NOT TO BE RETURNED TO BAUS – Operational from 01/01/2014
BAUS%&%Complex%operations%database%
Total%Cystectomy%for%Malignant%Disease%–%Operation%–%2014%
Patient%Details: %
Date%of%Birth%
Patient%NHS%Number %
Sex Patient%Hospital%Number
% Male% % Female%
Consultant%% % % % % % Centre
Q1%Date%of%diagnosis%of%bladder%cancer%% % %
%%%%%%(date&histological&diagnosis)&
%
Q2%Indication%for%Cystectomy%
%
%
% %
%
Q3/ 4/ 5%Pre&Operative%Clinical%categories:%% %
Q6%Urethral%Biopsy%performed If%yes
%
Q7%Pre&Operative%Imaging
% %
Q8%Serum%Creatinine%%% Q9%Serum%eGFR%%% % % Q10%pre&op%Hb%% %
%%%%%%%%% % %%%%% % % %
%
Q11%Patient%offered%Pre&operative%% % Q12%Patient%received%Neoadjuvant%Chemotherapy%
Neoadjuvant%Chemotherapy%
%
If%NO %
%
Q13%Status%Upper%tracts%
Q14%Date%of%Operation%% % % %% Q15/ 16%Grade%of%Main%Operating%Surgeon
Was%procedure%performed%jointly%with%another%consultant?

8. Centralisation – London Cancer

9. Caseload and Outcome
cancer, Gleason grade ≤6, and
clinically meaningful differen
homogenous group. Because
between surgeon experience
by the ability of individual su
capable surgeon who was u
therefore contribute to the be
ing curve), weperformed add
the sample to patients who
100 total surgeries and to pa
at least 250 total surgeries. C
results were unduly influenc
geons, we restricted the ana
completed the median num
Because there were some di
levels of surgeon experience,
addition, because it is possib
affected by differences in the
hormonal therapy before pat
cal recurrence, we performed
Fig. 2. The surgical learning curve for cancer control after radical pros-
tatectomy. Predicted probability (black curve) and 95% confidence
intervals (gray curves) for freedom from biochemical recurrence (BCR)
at 5 years after radical prostatectomy are plotted against increasing
surgeon experience. Probabilities are for a patient with typical cancer
severity (mean prostate-specifi c antigen level, pathologic stage, and
grade) treated in 1997 (approximately equal numbers of patients were
cancer, Gleason grade ≤6, and
clinically meaningful differen
homogenous group. Because
between surgeon experience
by the ability of individual su
capable surgeon who was un
therefore contribute to the be
ing curve), weperformed addi
the sample to patients whos
100 total surgeries and to pat
at least 250 total surgeries. C
results were unduly influence
geons, we restricted the anal
completed the median numb
Because there were some dif
levels of surgeon experience, w
addition, because it is possibl
affected by differences in the i
hormonal therapy before pati
cal recurrence, we performed
Fig. 2. The surgical learning curve for cancer control after radical pros-
tatectomy. Predicted probability (black curve) and 95% confidence
intervals (gray curves) for freedom from biochemical recurrence (BCR)
at 5 years after radical prostatectomy are plotted against increasing
surgeon experience. Probabilities are for a patient with typical cancer
severity (mean prostate-specifi c antigen level, pathologic stage, and
grade) treated in 1997 (approximately equal numbers of patients were
Vickers, J Natl Cancer Inst 2007;99:1171–7

10. Effect of Surgeon Experience on Cancer Control
There were1256 biochemical recurrencesamong the 7765 patients
in this study. Median follow-up for patients without recurrence
was 3.9 years. Only a small proportion of patients died without
experiencing abiochemical recurrence, resulting in a5-year overall
survival probability of 95%. This finding suggests that adjustment
for competing risk would have a minimal effect on any of our
analyses.
high (concordance index of
able model provides good c
model, greater surgeon exper
of prostate cancer recurrence
Figure 2 shows the 5-yea
chemical recurrence plotted
providesthe learning curve fo
prostatectomy. T here was a d
trol with increasing surgeon e
but no large change in recurr
rience. T o illustrate the asso
and outcome, wecompared th
wastreated by asurgeon with
tectomy (one with 10 prior o
was treated by a more exper
operations). We chose this d
because this number of prio
(275) for patientsand isalso t
the learning curve started to
of recurrence at 5 years were
for patients treated by surg
10.7% (95% CI = 7.1% to 15
with 250 prior operations, w
difference of 7.2% (95% C
needed to harm of 14; that
a surgeon with 10 as oppose
will experience a recurrence
We conducted a number
robustness of our findings
migration might haveaffected
Fig. 1. Probability of freedom from biochemical recurrence after radical
prostatectomy. The data are stratifi ed by surgeon experience (i.e., the
number of prior surgeries) at the time of the patient’s radical prostatec-
tomy, shown as numbers next to each curve.
Effect of Surgeon Experience on Cancer Control
T here were 1256 biochemical recurrencesamong the7765 patients
in this study. Median follow-up for patients without recurrence
was 3.9 years. Only a small proportion of patients died without
experiencing abiochemical recurrence, resulting in a5-year overall
survival probability of 95%. This finding suggests that adjustment
for competing risk would have a minimal effect on any of our
analyses.
high (concordance index of 0
able model provides good co
model, greater surgeon experi
of prostate cancer recurrence
Figure 2 shows the 5-yea
chemical recurrence plotted
providesthelearning curvefo
prostatectomy. T here wasa d
trol with increasing surgeon e
but no large change in recurre
rience. T o illustrate the asso
and outcome, wecompared th
wastreated by asurgeon with
tectomy (one with 10 prior o
was treated by a more exper
operations). We chose this d
because this number of prio
(275) for patientsand isalso th
the learning curve started to
of recurrence at 5 years were
for patients treated by surg
10.7% (95% CI = 7.1% to 15
with 250 prior operations, w
difference of 7.2% (95% CI
needed to harm of 14; that
a surgeon with 10 as opposed
will experience a recurrence a
We conducted a number o
robustness of our findings (
migration might haveaffected
Fig. 1. Probability of freedom from biochemical recurrence after radical
prostatectomy. The data are stratifi ed by surgeon experience (i.e., the
number of prior surgeries) at the time of the patient’s radical prostatec-
tomy, shown as numbers next to each curve.
Caseload and Outcome
Vickers, J Natl Cancer Inst 2007;99:1171–7

11. The Newcastle Consultant Body

12. Problems with Superspecialisation
• Nobody wants to do general urology any more
• Long travelling times for patients
• Needs working Hub and Spoke system (aftercare)
• What happens if somebody gets sick
• Jealousy from the non specialized surgeons
• 150 Cases – influencing patient selection?
• Don’t be a one trick Pony!

13. Summary
• Existing robotic systems not used efficiently
• Attempt to Increase outcomes/efficiency through
 Centralisation
 Multispecialty programs
 Superspecialisation