Eleven cutting-edge robotic surgery systems have been approved for use, potentially transforming care for thousands of NHS patients undergoing soft tissue and orthopaedic procedures.
The technology, which is capable of movements more precise than the human hand, has the potential to transform care for patients being operated on by surgeons in specialist NHS centres. Patient organisations told an independent appraisal committee that faster recovery times, shorter hospital stays and quicker return to work were the biggest benefits of robotic surgery. Patients also reported experiencing less pain and reduced scarring compared with traditional surgery.
The 11 systems can be used while further evidence is collected over the next three years demonstrating their cost-effectiveness for robot-assisted surgery, as part of NICE's Early Value Assessment process.
Five systems for soft tissue procedures – such as hernia repair, removal of tumours, and gallbladder removal – and 6 for orthopaedic surgery – such as full and partial knee replacement procedures and hip replacements – have received conditional approval. The use of robotic systems for prostatectomy, a surgical procedure to remove the prostate gland, either fully or partially, is outside the scope of these two pieces of guidance and already established practice in the NHS.
The recommendations will allow a coordinated approach to the expansion of innovative surgical technologies so that the NHS can maximise the benefits for patients. At the same time evidence will be collected to help NICE's committee validate these benefits to prove the technologies’ value and inform future implementation decisions.
Some robotic systems allow surgeons to perform procedures using mechanical arms controlled from a nearby console. Others are handheld. The surgical instruments attached to these arms can move with greater dexterity than the human hand, offering greater precision. They improve recovery times, reduce complications, and potentially increasing access to these procedures.
"These innovative technologies have the potential to transform both soft tissue and orthopaedic surgical care in the NHS. The data gathered over the next three years will allow us to evaluate exactly how these technologies can improve patient care and help ensure NHS resources are directed toward interventions that deliver meaningful clinical benefits and long-term value to our health service," said Dr Anastasia Chalkidou, programme director of NICE’s HealthTech programme
Dr Chalkidou continued: "Robot-assisted surgery may help overcome key limitations of conventional techniques through precise movements and enhanced 3D visualisation, potentially transforming surgical options and outcomes for NHS patients. Both applications could benefit patients who might not otherwise be candidates for minimally invasive approaches."
The robot systems each cost between £500,000 and £1.5 million and are typically only found in specialist centres which perform hundreds of procedures annually.
In 2011/12, only 20 per cent of robotic procedures were for conditions other than urological cancer. By 2023/24, this had grown to 49 per cent, with significant expansion in colorectal surgery, which now accounts for 25 per cent of all robotic procedures.
Orthopaedic robot-assisted surgery has seen the fastest rise, growing from approximately 300 procedures in 2018/19 to more than 4,000 last year.
"This is fantastic news for patients and shows that the NHS continues to find new ways to utilise the latest technological innovations to improve care. This will be a vital element of the 10 Year Health Plan which will be published in the coming months," commented Professor Sir Stephen Powis, NHS national medical director.
Professor Powis continued: “Robot-assisted surgery is crucial to the future of high-quality healthcare – and with benefits including shorter stays in hospital, faster recovery for patients and less invasive procedures these advancements will have a knock-on effect throughout the system and help patients get treated quicker.
“This is an important step forward as we continue to work to ensure everyone is able to get high quality care when they need it.”
"This is a further milestone in surgical innovation, and we are currently working hard to develop a national strategy that ensures patients across the country are able to access this treatment when they need it, regardless of location," added John McGrath, consultant urological surgeon at North Bristol NHS Trust, and chair of the NHSE Steering Committee for Robotic Assisted Surgery
John continued: “Later this month, we will release the first national guidance for the NHS in England that describes how robotic programmes should be configured, implemented and delivered as the services scale up. A key aspect in this is ensuring the necessary increase in expertise in robot-assisted surgery across the NHS workforce, so this technology can have the greatest possible impact for patients.”
The committee noted several important considerations for implementing robot-assisted surgery services in both specialties. These include ensuring equitable access across different regions, as current evidence shows lower uptake of minimally invasive surgery in more deprived areas of the country. Additionally, the availability of training, resources and staff to support these services will require careful planning.
For orthopaedic procedures, the technologies are recommended as an option for knee or hip replacements.
Companies must agree to generate evidence as outlined in NICE's evidence generation plans and maintain appropriate regulatory approval, including NHS England's Digital Technology Assessment Criteria (DTAC).
The committee will review both guidance documents based on evidence collected over the next three years to determine whether these technologies should be routinely adopted across the NHS.
