Nicholas Penney, Consultant Oesophagogastric Surgeon and Robotics Specialist at Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), will be a featured speaker at the upcoming AfPP Robotics Symposium being held at NNUH on Wednesday, 11 June 2025.
His session, titled “Development of an Oesophagogastric Robotic Service”, will explore the establishment of the robotic surgery programme at NNUH, the challenges faced, and the valuable insights gained along the way. Additionally, he will present a case study detailing the hospital’s first robotic-assisted oesophagectomy.
Leading the future of robotic surgery
Nicholas has recently been appointed as the Training Programme Director for Robotic Surgery for the East of England, where he will play a vital role in mentoring and training the next generation of robotic surgeons. His expertise in advanced laparoscopic and robotic surgery includes oesophagogastric cancer treatment, gallbladder disease, hiatus hernia repair, anti-reflux surgery, and upper gastrointestinal endoscopy.
Since joining NNUH as a Consultant Upper Gastrointestinal Surgeon in 2023, Nicholas has been instrumental in expanding the hospital’s robotic surgical capabilities. After qualifying from Imperial College London, he undertook higher surgical training in Surrey and Sussex. He gained further expertise in oesophagogastric cancer resections at the Royal Surrey County Hospital and the Royal Victoria Infirmary in Newcastle upon Tyne, one of Europe’s largest oesophagogastric cancer centres. During his time in Newcastle, he completed a Fellowship in Robotic Surgery under Professor Immanuel.
Pioneering the first robotic-assisted oesophagectomy at NNUH
One of Nicholas’s landmark achievements was performing the first fully robotic-assisted minimally invasive oesophagectomy (RAMIO) at NNUH. The procedure was conducted on 54-year-old Lee Moreton, a cancer patient from King’s Lynn, and took an extensive 14 hours to complete.
An oesophagectomy is a two-stage procedure performed within both the abdomen and chest. Both stages of the procedure, to remove a tumour from Lee’s oesophagus, were carried out robotically.
This complex surgery marked a significant milestone for NNUH, making it one of only five sites in the UK to offer this cutting-edge procedure. Traditionally, oesophagectomies involve either open surgery, which requires large incisions and leads to prolonged recovery times, or minimally invasive laparoscopic and thoracoscopic methods. However, robotic-assisted surgery provides greater precision, reduced pain, and faster recovery with lower incidences of complications such as pneumonia. Remarkably, Lee Moreton was discharged just five days post-surgery, two days earlier than average, with no complications.
Nationally, the average length of stay for oesophagectomy patients ranges from seven to 13 days across different centres. NNUH has an excellent track record, with a current average length of stay of seven days, one of the top performing centres in the country. The hope is that a robotic approach will help improve recovery further still for patients.
Nicholas said: “The case was very challenging due to the tumour being densely adhered to the lining of the heart and airways following radiotherapy treatment. Previously this would have necessitated the procedure being performed through an open thoracotomy incision. However, the improved 3D vision, dexterity and precision of the robot allowed the procedure to be performed minimally invasively through small incisions. The hope is that this type of robotic surgery will continue to reduce complications such as pneumonia following surgery, reduce length of stay and aid in a quick return to full function for our future oesophagectomy patients.”
Expanding access to robotic surgery
With over 50 robotic surgeries performed under his leadership at NNUH so far, Nicholas remains dedicated to making robotic-assisted surgery more accessible. He strongly advocates for increased investment in robotic technology and surgeon training, noting that robotic surgery offers significant benefits over previous techniques. These benefits include reduced pain and blood loss, fewer complications, shorter hospital stays and quicker recovery times. The surgery requires only very small incisions, which are possible thanks to the use of miniaturised cameras and instruments, controlled remotely by a surgeon, via the robotic system’s console. This allows greater visibility and precision than would be available in conventional techniques, making procedures easier for surgeons and safer for patients.
Nicholas said surgical robotics was transformative to surgery and outcomes.When he started working at NNUH there was no Oesophagogastric Robotic Service there. He is proud to have introduced and developed the service at NNUH and to have built a whole support team.
“We do highly complex surgeries, lasting many hours, and each member of the team has an important part to play,” said Nicholas.
“Each surgery is a real team effort. During robotic surgery the surgeon is not directly next to the patient, and you need total trust in your team and good communication is key. I know I have a great team around me, and it makes all the difference.”
Nicholas believes robotic-assisted procedures should become the gold standard in oesophagogastric surgery. However, further development is required to improve access. As a dedicated educator, he actively contributes to both undergraduate and postgraduate surgical training, and trains surgeons throughout the region.
Looking ahead to the Robotics Symposium
Nicholas is excited about the AfPP Robotics Symposium and sees it as an opportunity to showcase the advancements in robotic surgery at NNUH.
“It will be a great opportunity to showcase all the robotics work we do here at NNUH and to share our experiences with others in the field,” he said.
To learn more about the AfPP Robotics Symposium, visit AfPP Events.
