Date Published: 6 April 2011

Latest developments to advance keyhole surgery for bowel cancer

Robotic surgery for bowel cancer has been brought closer to reality by researchers at Leeds University, England. They are testing a robotic system that may eventually improve the quality of 'keyhole' bowel cancer surgery. This Robotic versus Laparoscopic Surgery (ROLARR) trial is managed by the University of Leeds' Clinical Trials Research Unit (CTRU), part of Leeds University's School of Medicine. The trial is a partnership between the University of Leeds and Leeds NHS Teaching Hospitals Trust and is funded by a research grant and additional financial support from Leeds University's Biomedical and Health Research Centre.

Many operations to remove bowel tumours can now be done using keyhole surgery, during which surgeons use special elongated instruments, inserted through small holes in the abdominal wall, to remove cancers. In the hands of an experienced surgeon, keyhole surgery is just as good as open surgery for curing bowel cancer. Patients who have their tumours removed via keyhole surgery also benefit from shorter hospital stays and faster recovery times. However, removing a bowel cancer using keyhole surgery is a challenging procedure. Sometimes surgeons have to switch to open surgery mid-way through the operation and make a large cut in the patient's stomach to get to the cancer.

Robotic systems have been developed that can make it easier for surgeons to see and take out bowel cancers using keyhole techniques. These systems let surgeons sit comfortably a few feet away from the patient and watch magnified video images of the operation. Guided by these images, the surgeon then uses precise hand movements to carefully control a set of robotic surgical instruments inside the patient's body to remove the cancer.

In order to find out what difference robotics actually make in practice researchers are comparing what happens to bowel cancer patients who undergo robotic-assisted keyhole surgery compared with those who have standard laparoscopic surgery.

The ROLARR trial will show whether robotic assistance makes it easier to remove bowel tumours using laparoscopic or 'keyhole' techniques and whether use of this approach reduces the likelihood of the cancer returning. The study will also consider whether giving surgeons a robotic 'helping hand' means that patients spend less time in hospital after keyhole bowel surgery and suffer fewer complications.

David Jayne, Senior Lecturer in Surgery at the University of Leeds and Chief Investigator for the ROLARR (Robotic versus Laparoscopic Surgery) trial, said:

" It has been very exciting to see the emergence of robotic surgery and I am hopeful that such systems will be of real benefit to patients with bowel cancer. However, it is vitally important that the value of robotic assistance is evaluated properly. Surgeon, patients, and healthcare providers need to know what difference this expensive and specialist technology will make - which is exactly what this study will show."

Professor Julia Brown, Director of Leeds University's Clinical Trials Research Unit, said:

" We are delighted to be building on our track record in the evaluation of new surgical procedures and to be extending into a worldwide evaluation."

The first patients to take part in this trial of next-generation surgical technology are now being recruited. The study will eventually involve 400 patients in more than 20 centres across Europe, the US and Asia.

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