Experiences of a \u201cCOVID protected\u201d robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

Jeremy R Huddy,A Shiyam Nizar,Ralph Smith,Manar Malki,Neil Barber,Matthew Crockett,Henry S Tilney

doi:10.1007/s11701-021-01199-3

Jeremy R Huddy, A Shiyam Nizar + Show 5 more

Open Access

https://doi.org/10.1007/s11701-021-01199-3

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Abstract

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

Highlights

Preparation for the current coronavirus pandemic resulted in the cessation of elective surgery at NHS hospitals with an estimated 43,000 operations being cancelled per week in the United Kingdom alone [1]
We report our early experience of establishing a “COVID protected” unit for elective robotic surgery at a large acute care district general hospital with an established robotic surgery programme and a tertiary referral service for renal cancer
We report our experience of re-establishing elective robotic surgery immediately following the initial surge period of the coronavirus outbreak

Summary

Introduction

Preparation for the current coronavirus pandemic resulted in the cessation of elective surgery at NHS hospitals with an estimated 43,000 operations being cancelled per week in the United Kingdom alone [1]. Invasive surgical techniques such as robotics have been affected by the associated changes to surgical practice as early recommendations from national bodies favoured open approaches to surgery largely based on the theoretical risk of aerosolisation of virus particles in carbon dioxide insufflation [3]. These guidelines have been relaxed over recent weeks as we shift focus to the resumption of elective services in a way that mitigates the risks for patients and staff. Ethnic minority groups have been reported to be disproportionately affected by COVID-19 with both a higher incidence and severity [8]

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