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Using robotics in rectal cancer surgery

Project Lead
David Jayne, Clinical Director, Colorectal Therapies Healthcare Technology Co-operative

The technology

Robotic surgery is designed to enhance the accuracy and safety of complex surgical procedures. Only one robotic system is currently commercially available. Called the Da Vinci System, it is made by an American company, Intuitive Surgical. Using the system, a surgeon will sit at a console from where he or she will control four robotic arms to carry out the surgery. The arms are designed to have a greater range of motion than humans do, and they are also programmed to cut out flaws, such as hand tremor.

Several machines are now in operation in hospitals in the UK, where they are most commonly used to carry out prostate surgery.

The Da Vinci robot has the potential to enable colorectal surgery to be performed with greater accuracy and safety. The drawback is that the system currently costs £1.7 million, and, currently, there is insufficient evidence that it improves outcomes for patients over conventional, laparoscopic techniques.

Our role

The ROLARR (Robotic versus Laparoscopic Resection for Rectal cancer) trial was set up to investigate the comparative benefits of robotic and laparoscopic techniques in colorectal surgery. The trial is co-ordinated by HTC Clinical Director, Professor David Jayne in collaboration with Leeds Clinical Trails Research Unit, and is taking place in 26 sites across 10 European countries. It involves 40 surgeons and has recruited 471 patients.

Each patient is randomly selected to receive either laparoscopic or robotic surgery. Factors under consideration will include the technical ease of the surgery, as well as an assessment of the outcomes for patients and their quality of life. Initial analysis suggests that in certain patients, who are particularly challenging for surgery, the robot may offer a benefit in helping the operation to be completed with minimally invasive surgery.

Because of the high costs of the system, it is also particularly important to assess the health economic impact of its adoption. This will enable the NHS and other healthcare decision-makers to gain a clear picture of its cost-effectiveness.

The trial is funded by the Medical Research Council and managed by the National Institute for Health Research.

Next steps

The study is expected to be completed in 2018, when the final three-year follow up has been completed. The results will be used to inform healthcare strategies produced by the NHS, and other service providers.