Robotic-assisted surgery: what it is, benefits, risks and what to ask

Robotic-assisted surgery is not a separate type of operation. The operation itself, such as removing part of the bowel or a hysterectomy, stays the same; what changes is how it is carried out. The Manchester leaflet explains that most operations inside the abdomen can be done by an open approach with a single larger cut, by a laparoscopic or keyhole approach with several small cuts, or by a robot-assisted approach, which is another keyhole technique using robotic arms controlled by the surgeon.

The robot has several arms. In the system described in the Manchester leaflet there are four: one holds a high-magnification 3D camera inserted through one of the small cuts, and the others hold the instruments the surgeon uses. The surgeon sits at a console in the same room, a short distance from you, and controls the arms. You are asleep under a general anaesthetic throughout.

University College London Hospitals notes that the robotic tools have a wrist-like structure that mimics the human hand, which standard keyhole instruments lack, and that the surgeon has a better view in 3D and more control over the tools. The size of scars is similar to keyhole surgery and much smaller than open surgery.

NHS trusts use robotic systems across several specialties. The sources read for this page include patient information about robotic colorectal surgery at University College London Hospitals, robot-assisted gynaecology at Saint Mary's in Manchester, and a Kingston and Richmond leaflet covering ear, nose and throat, urology and general surgery. UCLH notes that it has performed robotic surgery in urology for several years while its use for colorectal surgery was newer.

Not all operations are done with a robot. The Kingston leaflet says your surgeon will decide if it is an option for you, and that if it is, you can discuss the advantages and disadvantages of robotic and non-robotic options with your surgeon and choose what is best for you.

The leaflets describe benefits as possibilities rather than guarantees. The Manchester leaflet lists, compared with open surgery, shorter hospital stays, faster recovery after leaving hospital, quicker return to activities such as driving, less pain, a reduced risk of wound infection, less blood loss meaning a reduced need for blood transfusion, and reduced scarring. Compared with traditional keyhole surgery, it says robot-assisted surgery helps many patients by reducing the chance of needing to change to an open operation during the surgery, and that it allows keyhole surgery for some patients in whom it is not usually possible with a standard laparoscopic approach.

UCLH makes similar points for bowel surgery. It says robotic surgery can result in more gentle handling of organs and make it easier to operate in hard-to-reach areas such as the pelvis, with less blood loss, less damage to surrounding structures such as nerves and sometimes a faster recovery. It says patients can often have less pain and a smoother recovery, which can mean going home a day earlier than with open surgery.

The Kingston leaflet adds smaller incisions of about the size of a fingertip and a lower risk of wound complications such as hernia. Because the wording differs between hospitals and operations, treat the lists as a guide to what may be possible, and ask your surgeon which benefits apply to your own operation.

The Manchester leaflet says the possible risks and complications of robotic-assisted surgery are no different from those of traditional keyhole surgery. It lists the need to convert to an open operation during the surgery, shoulder discomfort from trapped gas under the ribcage that usually settles within a few days, nerve or muscle problems from being in a particular position on the operating table for longer, and hernias at the incision sites. Other complications are those common to any surgery, such as infection and blood clots.

UCLH lists the main risks of colorectal surgery as infection, bleeding, a clot in the calf veins and, if two sections of bowel have been joined, that the join can come apart, and says the risks of robotic surgery are similar to keyhole surgery. It also says robotic operations can take longer than standard keyhole surgery.

The Kingston leaflet says that depending on the operation there may be specific risks associated with the robot, which your surgeon will explain beforehand. The leaflets do not claim that the robot removes risk.

Preparation is much the same as for other surgery. The Manchester leaflet describes a pre-assessment appointment at which a doctor explains the operation and you have tests and a discussion with a nurse. It advises smokers to stop or cut down in the days before the operation to reduce the risk of chest problems, to eat a healthy diet, to take gentle exercise if you are well enough, and to organise things at home in advance, such as stocking the freezer and arranging help with heavy housework.

Consent is required by law. UCLH says staff will explain the risks, benefits and alternatives before asking you to sign a consent form and that you should ask again if you are unsure about any aspect.

The Kingston leaflet says the surgeon will usually have been qualified and experienced, and that a surgeon still training to use the robot is supervised by another surgeon, called a proctor, for a set number of procedures; if a proctor will be present, your surgeon will tell you beforehand.

Recovery depends on the operation more than on the use of a robot. The Kingston leaflet says you may be able to go home the same day or within a couple of days depending on the surgery, and that you may feel mild pain, swelling or bruising around the incision sites. You will receive advice on pain control and wound care, a discharge letter and a follow-up appointment.

UCLH says recovery from robotic colorectal surgery is similar to recovery from keyhole surgery and can be faster than after open surgery. You are likely to have some soreness in the abdomen, will start with clear fluids and progress to solid food, and are encouraged to get out of bed and walk around the ward. The Kingston leaflet says people can usually return to normal activities within a few weeks depending on the surgery, and your surgeon will guide you on work and exercise.

The Kingston leaflet suggests questions to put to your doctor, which are useful whichever hospital you attend.

• What medical and surgical options do I have for my condition, and what is the best treatment?

• What are the differences between the types of operation, robotic and non-robotic?

• How much training and experience does the surgeon have with the surgical robot?

• How can I prepare for surgery, and how will I feel afterwards?

• If the robot cannot be used or the operation has to change, what happens next?

Robotic surgery is offered in NHS hospitals for selected operations and may also be available privately. Availability depends on whether your local hospital has a robotic system and a team trained to use it for your particular operation, so it is a reasonable thing to ask at your first surgical appointment. In either setting, the decision about approach should be made jointly with your surgeon, based on your condition, your general health and the evidence for your operation.