ROBOTIC surgery has morphed from a science fiction fantasy to one of the fasting growing technologies in modern medicine, and a new training centre at Dundee is set to put Scotland at the cutting edge.

The newly refurbished Dundee Institute for Health Simulation (DIHS) will launch Scotland's first training programmes for robot-assisted surgery in 2019, initially focusing on gynaecology, urology, upper and lower abdominal procedures and ear, nose and throat (ENT) operations.

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In time, robots are even expected to become the norm for orthopaedics, cardiothoracic and brain surgery.

Medical students will be able to hone their skills using a da Vinci robot, the first generation of robotic surgery. Three of these machines are already in use in NHS Scotland, largely geared to prostate surgery.


The centre is also expected to attract medics from around the world as well as training experienced NHS surgeons and the wider surgical teams, including nurses and anaesthetists, in how to work together in theatre when the lead surgeon might be miles away performing the procedure remotely, via computer.

Dr Vanessa Kay, a gynaecologist and co-director of the Dundee Institute for Healthcare Simulation, said: "You have to understand it's not a robot doing the surgery - it's 'robotic-assisted surgery'.

"You still have a surgeon doing the operation, but what it means is the surgeon can be distanced from the patient. They don't even need to be in the same country.

"They're sitting comfortably at a console, they're looking at the images in 3D, these can be very magnified, and the robot transfers very fine movements from the surgeon very precisely onto the patient.

"The new robots on the market really mimic very closely what you would do in open surgery. So the thinking is this is going to have a shorter training time, and there's evidence that it is safer.

"Patients recover quicker, there's less blood loss, fewer complications, but it's also more comfortable for a surgeon.

"I might do a five-hour operation laparoscopically where I have to hold my body in a very contrived position, quite twisted, looking at a television screen and moving quite long instruments over a patient's abdomen.

"Whereas with robotic surgery, I can sit with a cup of coffee at a computer console. It's much better for the surgeon in terms of back injury and being able to perform the surgery at a high level."

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The rise of robotic-assisted surgery builds on the benefits already garnered from minimally-invasive laparoscopic - or 'keyhole' - surgery, a technique famously pioneered by Professor Sir Alfred Cuschieri in Dundee in the 1990s.

In fact, without keyhole surgery robotic surgery itself would not exist, since it adheres to laparoscopic techniques.

In future, the ability to perform complex surgery remotely might pave the way to routine tele-surgery on the NHS in Scotland, especially in remote and rural hospitals which struggle most to recruit specialists.

However, the prohibitive cost of a da Vinci robot - around £1.5 million for installation and £85,000 a year for upkeep - stands in the way for now.

"It is becoming more cost effective, but it still would be quite expensive to set up in smaller hospitals," said Dr Kay. "But as with any technology, it gets cheaper the more you use it. I think the price will come down and that would certainly be a future aspiration."

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As for the possibility of melding of robotic assisted surgery with artificial intelligence to create android surgeons or robots that need no human guidance - Dr Kay is sceptical.

"As a surgeon, I can't see that would ever be possible. Patients are very unpredictable, the response when they're anaesthetised is unpredictable, even the anatomy of individuals is very different so you do need someone who's trained to make very difficult decisions quickly, to make clinical judgements based on experience.

"I'm not a robot expert, but I cannot foresee being able to replace the surgeon. At least in the foreseeable future."


In addition to robotic surgery training, the Dundee centre will use virtual reality to train students in anatomy using 3D organs or plunge them into simulated scenarios, such as warzones or an intensive care unit where a patient is going into cardiac arrest.

Virtual reality can also be used to build team-work, communication and leadership skills among surgical teams by enabling them to operate together on simulated but lifelike patients.

"There is increasing evidence that it can improve healthcare training," Dr Kay added.

Dr Catherine Calderwood, Chief Medical Officer for Scotland, said: “With Scotland already being a destination of choice for many healthcare trainees from around the world, DIHS has the potential to make a significant impact locally, nationally and internationally.”