The robotic surgery revolution is coming to the NHS but just how safe is it?

A massive robotic surgery revolution is underway. The rollout is imminent, but just how safe is it? Recently, The Express watcheda pioneering lung cancer operation at Guy's Hospital, during which the patient was expected to be "awake within half an hour, sitting up in a chair and having a cup of tea."

The benefits seem clear and undeniable. But there have been a number of tragedies in the past decade alone. Even with robotic-assisted surgery "quickly becoming the norm", experts are warning that patient safety must be at the forefront.

After all, as Dr Helena Surana, joint co-editor in chief of BMJ Innovations, highlights, we must remember "that this is always robot-assisted surgery-not purely robotic surgery."

She acknowledges that the technology "holds huge promise" but emphasises that "there's always a need for a big team of skilled people behind every operation."

In 2015, Newcastle man Stephen Pettitt died after a pioneering heart operation. Coroner Karen Dilks had said his tragic death had come as a "direct consequence of the operation and its complications" and "in part, because the operation was undertaken with robotic assistance".

With a projected annual growth rate of 70,000 to half a million over the next decade, the expansion shows no signs of slowing down. NHS National Medical Director Professor Meghana Pandit has said this technology will help build a health service "fit for the future."

Slashed recovery times, reduced waiting lists, and reduced pain are just a few of the benefits for patients and the NHS at large. But in addition to complications arising in the technology itself, there is potential for error in smoothly operating it.

Dr Surana emphasises, "it's important to put patient safety as well as efficiency at the heart of developing new technologies and services," and that "research shows the best use of these tools is on precision-focused repetitive tasks, and surgical planning."

Dr Ashley McKimm, also a joint co-editor-in-chief at BMJ Innovations, echoes the emphasis on safety.

While confirming that "we're seeing an unprecedented acceleration in surgical technology", he emphasises that "advances need to be matched by rigorous training, oversight, and evaluation to ensure patient safety keeps pace with innovation".

Dr McKimm acknowledges that "the benefits can be significant - greater precision, quicker recovery, fewer complications" and that robotic-assisted surgery is indeed "transforming how complex procedures like lung cancer surgery are performed.

Indeed, surgeons are also promised massively beneficial advantages when it comes to manual tasks. Yet, getting to grips with the technology can be a learning curve itself, and managing it can be prone to complications and negligence.

At Guy's Hospital, lead surgeon Tom Routledge explained that carrying out manual keyhole surgeries is "quite brutally destructive of surgeons because you're spending hours in these odd and uncomfortable positions," and discomfort can impair decision-making.

However, he also stated that learning to operate the robot is a bit like learning to drive a car, and that it takes time "to move from being a bit clunky and having to think about what to do, to getting ever more fluid and controlled".

In the case of Stephen Pettitt's death in 2015, the assistant surgeon stated he "could have done with more dry-run training." Mr Thasee Pillay told the coroner that he had "lost sense of time", elaborating, "during news procedures, sometimes you get caught up in the fact, let's get it done'".

He stated that surgeons needed to carry out 40 robotic operations to overcome the learning curve." During the operation, the two proctors had left and he'd assumed they'd just taken a coffee break".

Across the globe, as recently as 2024, it was reported that a Florida woman, Sarah Sultzer, had died (in 2021) after a surgical robot burned her small intestine.

Her husband filed a lawsuit claiming that Intuitive Surgical Inc. failed to warn his wife of issues that would have caused her to forgo the use of the company's da Vinci surgical robot for the procedure in 2021.

Across the UK, more than 200 da Vinci systems made by the technology company Intuitive are used by hospitals.

The NHS Kingston and Richmond website states that " the risks of having surgery with a robot are no higher than the risks with traditional techniques."

However, it cautions that "depending on the operation, there may be specific risks associated with the robot. Your surgeon will explain these beforehand."

At University Hospital Coventry, where robotic surgery was recently introduced for some patients, an NHS Trust leaflet from UHCW outlines the risks for those undergoing surgery in the head and neck area.

The leaflet emphasises the major advantage of the robotic-assisted procedure: the telescope, which allows a much clearer view of the back of the tongue when tissue needs to be removed.

Some disadvantages are highlighted, including the surgery possibly being slower and the patient needing to be anesthetised for a longer period of time. This is because the robot takes time to set up and may be slower than conventional surgery.

Meanwhile, a similar informational leaflet from East Kent Hospitals University on transoral robotic-assisted surgery (TORS) for head and neck cancer patients states that "you do not have to agree to undergo TORS." Patients will be given time to think about their decision and to discuss this.

The main complications associated with robotic-assisted head and neck surgery on the UHCW leaflet list complications of robotic-assisted surgery as bleeding, pain on swallowing, swelling, infection, and limited mouth opening.

However, it cautions that "these risks apply to all surgical procedures around the jaws, not just robotic-assisted surgery". It also outlines that tooth injury may arise from the instrument that is placed in the mouth to keep it open in order for surgery to be carried out at the back of the throat.

The leaflet states that tooth injury by an instrument is rare, but surgeons will check if patients have any loose teeth beforehand and warn them of the risk.

Patients are given instructions about what to do if they have a problem when they leave the ward, and information is also sent to their GP.