A UK first: robotic operations for skin cancer patients

14th December 2011

 

This year we carried out the UK’s first robotic operation for skin cancer patients at Guy’s and St Thomas’ Hospital. To date only two patients with the skin cancer melanoma have had this procedure in the USA, which shows just how cutting-edge this treatment is.

Aside from being a pioneering approach to treating cancer patients, the successful surgical procedure we have developed shows what can be achieved by working in multi-disciplinary teams; in this case the combination of plastic surgery techniques and the expertise of urologists was critical. 

The 90-minute robotic procedure offers considerable benefits compared to traditional ‘open’ surgery for skin cancers in the pelvic region. Rather than an invasive pelvic dissection, patients are left with smaller wounds and scars and a lower risk of infection. The robotic operation has also meant a faster recovery period with the patient often able to leave hospital after a twenty four hour stay.

As plastic surgeons, we are always looking at new ways of working, offering patients more choice and a better way of getting them back to full function and normality as quickly as possible. In this case it involved approaching the urology team and using their equipment. Their co-operation and collaboration have been essential.  
Currently the national skin cancer guidance for best melanoma care, advises that some patients have a prophylactic pelvic procedure. Due to the risk of complications after open pelvic surgery, some patients can be reluctant to undergo any further surgery. Now we can offer an alternative to open surgery for these patients that reduces both the risks of complications and length of stay. Robotic surgery has been used for prostate, renal and gynaecology procedures, but ironically had not been used for skin cancer patients, who often have wound healing problems with delicate skin.

The new da Vinci Si dual console has four arms: one with a 3D camera which acts as the surgeons’ ‘eyes’, a right arm and a left arm, and an additional fourth arm to replace the use of a theatre assistant. It creates a three handed surgeon. It filters any tremor, scales motion by 5:1 and has a variety of fully flexible instrument tips with 7 degrees of freedom. It also has a dual console which allows for two surgeons to directly collaborate during the same procedure. 

I would like to thank Professor Dasgupta and Mr Ben Challacombe who were the urology team involved in these operations.

Case study: 
73-year-old Margaret Everest was the first patient in the world (to our knowledge), to undergo the robotic procedure for Merkel Cell skin Cancer in July. Margaret’s cancer had spread to the lymph nodes in her groin. The robot was used to remove eight lymph nodes. 

Margaret said: “I can’t get my head around being the first to have the procedure; it’s such a miracle that this type of technology has been invented. I’m glad I was able to get the ball rolling. The surgeons must feel like the first astronaut on the moon! I had an open procedure for the same form of cancer in February and the difference between the two operations is huge. The open procedure left me with an eight inch scar, and I stayed in hospital for a week. With the robotic operation, I suffered no pain at all and I was feeling back to normal within 24 hours. I’ve only got a tiny scar left.”

Jenny Geh 
BAPRAS Full Member
 

 

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