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Million patients a year needlessly enduring major surgery as NHS hospitals are not adopting modern practices, research finds

A report claims hospital trusts are ignoring the benefits of keyhole surgery - PA
A report claims hospital trusts are ignoring the benefits of keyhole surgery - PA

A million patients a year could be needlessly enduring major surgery because NHS hospitals are not adopting modern practices, research has found.

Up to three quarters of patients who could have keyhole procedures are forced to undergo open surgery, putting them at higher risk of blood loss, pain and infection.

A report claims hospital trusts are ignoring the benefits of keyhole surgery – also known as laparoscopic or minimal access surgery – because of pressure to cut down waiting times and reduce costs.

Leading surgeons said patients can be treated just as effectively and recover more quickly if modern techniques are used, leading to shorter hospital stays and reducing the number of costly complications.

Professor Prokar Dasgupta, professor of robotic surgery at King’s College London and The London Clinic, said: “If there is something you can do through keyholes rather than a big cut it is not surprising that the patient will lose less blood and as a result have less pain and get out of hospital earlier. So the patient benefits are undoubted.”

But experts raised concerns hospitals were failing to offer keyhole surgery to patients because of a combination of cost pressures, a lack of trained surgeons and a reluctance to change, with traditional surgeons “set in their ways”.

Keyhole surgery costs more than traditional open procedures because it requires more expensive equipment and takes longer to train surgeons to be proficient, according to an Office of Health Economics report due to be published next week.

The report, Barriers to Uptake of Minimal Access Surgery in the United Kingdom, cited research on NHS operations for endometrial cancer patients which found keyhole procedures took around 37 minutes longer than open surgery – and suggested surgeons under pressure to reduce waiting list times may be opting for the quicker option.

But the same study found keyhole surgery patients tended to stay in hospital for two days less and suffered fewer complications, ultimately saving the NHS money.

The NHS watchdog the National Institute for Health and Care Excellence recommends keyhole surgery for common operations including colorectal cancer treatment, hernia repair and hysterectomies.

But in England and Wales in 2016/17, more than 1 million patients had open surgery when they may have been eligible for a keyhole procedure.

In contrast, 339,000 patients (24 per cent) had keyhole surgery and 16,000 (1 per cent) had robotic keyhole surgery. Only a third of NHS hysterectomies in the same year were performed using keyhole techniques, while 64 per cent – 31,000 operations – were done via open surgery.

The UK’s keyhole surgery rates lag behind those of other major European economies. Eurostat figures show only 20.6 patients per 100,000 had a hysterectomy by keyhole surgery in 2015 in the UK, compared to 30.7 in France and 45.6 in Germany.

Prof Dasgupta added: “The UK has done good things but we have a distance to go. Cost, training and culture are the three main reasons why there are barriers in the way.

“It is going to take a cultural shift. I think people are often set in their ways, many traditional surgeons are unwilling to accept that minimal access [surgery] has any benefits for their patients… The NHS has many other demands - minimal access surgery is not highest on the list.”

Dr Mark Slack, consultant gynaecologist at Addenbrooke’s Hospital, Cambridge, and medical director at CMR Surgical - which commissioned the report - said surgical robots could help improve the UK’s keyhole surgery rates.

He said: “Minimal access surgery is technically difficult to do. If you’re going along doing something that you’re comfortable with it’s a [big] thing to retrain to pick up new techniques. Robots can help bridge that gap and overcome some of the technical difficulties.”

But he said the cost of robots needed to come down in order for them to be value-for-money for hospitals. Commenting on the report, Professor Timothy Rockall of the Royal College of Surgeons, said: “Depending on the procedure, minimally invasive surgery is linked to a reduction in blood loss, pain, risk of infection and other surgical complications, compared to open surgery. This can result in quicker recovery times for patients and a shorter hospital stay.  

“However, further data collection and analysis are needed to demonstrate the overall benefits to patients of using surgical robots to perform this type of surgery. It is also important to stress that robots are not suitable for all procedures and may confer no advantage despite much higher cost.

“The introduction of surgical robots in NHS hospitals has been somewhat haphazard. This has resulted in some parts of the country having more surgical robots than are needed, while in other areas there is an undersupply.  The NHS could be better at centrally planning the use of surgical robots for procedures where there is evidence of benefit and identifying where patient need is greatest.”