Robotic assistance for keyhole surgery

The Royal College of Surgeons has recently carried out research into how the European Working Time Directive (EWTD) has impacted the NHS, one year since it was implemented. One of the most important conclusions from the study showed that almost two-thirds of surgeons are now forced to operate without an assistant, as there are simply not enough junior doctors to go round. However, last year, a new robotic device used to assist laparoscopic surgeons was approved for use in Europe and the US, which not only made robotic technology affordable, but offered the potential to overcome the unintended consequences of limiting junior doctors’ hours. The FreeHand robotic system puts the surgeon in complete control of the camera by enabling him to guide it using simple head movements. The scope is moved by a hands-free controller, worn on a headband, or attached to a surgical cap and an activation pedal. Surgeons can control the tilt and pan movements, zoom in and out, and control the speed of the camera’s movement. In simple procedures, this removes the need for an assistant, often a junior surgeon, to hold the camera, reducing the number of surgeons required for the operation.

Consultant urological surgeon, Mr Anand Kelkar, is one of the surgeons to have introduced the robotic camera controller (developed by UK robotics company Freehand Surgical) to three hospitals in Essex. Mr Kelkar, who specialises in urological cancer and laparoscopic surgery, has recently had FreeHand installed at King George Hospital in Goodmayes (part of Barking, Havering and Redbridge University Hospitals NHS Trust); has used it at the Nuffield Health Brentwood Hospital and Spire Hartswood Hospital; and will shortly be using it at Spire Roding Hospital. He explained: “I have carried out over 60 laparoscopic operations using this technology and can now carry out kidney surgery alone, without the need for an assistant. Previously, a prostatectomy required two assistants, now I only need one, thereby saving hours of work, time and money. I am able to focus on training my junior surgeon better and can concentrate more on the operation without needing to hold the camera.” Mike Parker, consultant surgeon at Darent Valley Hospital in Dartford and council member of the Royal College of Surgeons, would like to see the EWTD abolished, but believes the device could offer a solution for surgeons who are required to carry out operations on their own: “FreeHand is very quick to learn, easy to use and you can perform the operation single-handed without fear,” he commented, adding: “Controlling the device becomes second nature very quickly – it gives me a superb view, unhindered by shake or tremor. It is also very affordable. Every surgery department in the NHS should consider investing in FreeHand, especially now, with the increasing shortage of junior doctors.”

Affordability