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The study, published in听JAMA听and听funded by The Urology Foundation with a grant from the Champniss Foundation,听also found听robotic surgery reduced the chance of readmission by half (52 per cent), and revealed a 鈥渟triking鈥� four-fold (77 per cent) reduction in prevalence of blood clots (deep vein thrombus & pulmonary emboli) - a significant cause of health decline and morbidity - when compared to patients who had open surgery.

Patients鈥� physical activity - assessed by daily steps tracked on a wearable smart sensor - stamina and quality of life also increased.

Unlike open surgery, where a surgeon works directly on a patient and involves large incisions in the skin and muscle, robot-assisted surgery allows surgeons to guide minimally invasive instruments remotely using a console and aided by 3D view. It is currently only available in a small number of UK hospitals.

Researchers say the findings provide the strongest evidence so far of the patient benefit of robot-assisted surgery and are now urging National Institute of Clinical Excellence (NICE) to make it available as a clinical option across the UK for all major abdominal surgeries including colorectal, gastro-intestinal, and gynaecological.

Co-Chief Investigator, Professor John Kelly, Professor of Uro-Oncology at 911爆料网鈥檚 Division of Surgery & Interventional Science and consultant surgeon at University College London Hospitals, said: 鈥淒espite robot-assisted surgery becoming more widely available, there has been no significant clinical evaluation of its overall benefit to patients鈥� recovery.

鈥淚n this study we wanted to establish if robot-assisted surgery, when compared to open surgery, reduced time spent in hospital, reduced readmissions, and led to better levels of fitness and quality of life; on all counts this was shown.

鈥淎n unexpected finding was the striking reduction in blood clots in patients receiving robotic surgery; this indicates a safe surgery with patients benefiting from far fewer complications, early mobilisation and a quicker return to normal life.鈥�

Co-Chief Investigator Professor James Catto,听Professor of Urological Surgery听at the Department of Oncology and Metabolism, University of Sheffield, said: 鈥淭his is an important finding. Time in hospital is reduced and recovery is faster when using this advanced surgery.

鈥淯ltimately, this will reduce bed pressures on the NHS and allow patients to return home more quickly. We see fewer complications from the improved mobility and less time spent in bed.

鈥淭he study also points to future trends in healthcare. Soon, we may be able to monitor recovery after discharge, to find those developing problems. It is possible that tracking walking levels would highlight those who need a district nurse visit or perhaps a check-up sooner in the hospital.鈥�

鈥淧revious trials of robotic surgery have focused on longer term outcomes. They have shown similar cancer cure rates and similar levels of long term recovery after surgery. None have looked at differences in the immediate days and weeks after surgery.鈥�

Open surgery remains the NICE 鈥済old standard鈥� recommendation for highly complex surgeries, though the research team hope this could change. 听

Professor Kelly added:听鈥淚n light of the positive findings, the perception of open surgery as the gold standard for major surgeries is now being challenged for the first time.

鈥淲e hope that all eligible patients needing major abdominal operations can now be offered the option of having robotic surgery.鈥�

Rebecca Porta, CEO of The Urology Foundation said: 鈥淭he Urology Foundation鈥檚 mission is simple - to save lives and reduce the suffering caused by urological cancers and diseases. We do this through investing in cutting-edge research, leading education and supporting training of health care professionals to ensure that fewer lives will be devastated.

鈥淲e are proud to have been at the heart of the step change in the treatment and care for urology patients since our inception 27 years ago, and the outcomes of this trial will improve bladder cancer patients鈥� treatment and care.鈥�

Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the bladder muscle and can lead to secondary cancer in other parts of the body. About 10,000 people are diagnosed with bladder cancer in the UK every year and over 3,000 bladder removals and reconstructions are performed. It is one of the most expensive cancers to manage.

Trial findings

Across nine UK hospitals, 338 patients with non-metastatic bladder cancer were randomised into two groups: 169 patients had听robot-assisted radical cystectomy (bladder removal) with intracorporeal reconstruction (process of taking section of bowel to make new bladder), and 169 patients had open radical cystectomy.

The trial鈥檚 primary end-point was length of stay in hospital post-surgery. On average, the robot-assisted group stayed eight days in hospital, compared to 10 days for the open surgery group 鈥� so a 20% reduction.听 Readmittance to hospital within 90 days of surgery was also significantly reduced 鈥� 21% for the robot-assisted group vs 32% for open.

A further 20 secondary outcomes were assessed at 90 days, six- and 12-months post-surgery. These included blood clot prevalence, wound complications, quality of life, disability, stamina, activity levels, and survival (morbidity). All secondary outcomes were improved by robot-assisted surgery or, if not improved, almost equal to open surgery.听

This study, and previous studies, show both robot-assisted and open surgery are equally as effective in regards cancer recurrence and length of survival.

Next steps

The research team is conducting a health economic analysis to establish the quality-adjusted life year (QALY),听which incorporates the impact on both the quantity and quality of life.

Patient case studies

John Hammond, retired, age 75, from Doncaster, said: "I left my symptoms too long, and found out that I had a tumour in the bladder. I was lucky to see Professor听Catto听and after being given options, I chose the operation to have my bladder removed and a stoma in place.听

"I had the听operation in August 2019 and was aware that it was robotic surgery in a trial and was keen to take part; in fact I was pleased to be in a position to help anybody else in the future with this type of surgery. The operation was successful, and the whole team was hugely supportive.听

"Amazingly, I was walking the next day and progressed excellently, improving my walking each day. I was in no pain and just had to adjust to the stoma bag. I have fully recovered from the operation and throughout I knew I was in professional hands. I was home about five days after surgery and am grateful to Professor Catto and his team that I did not have to stay in hospital for longer than necessary."

Frances Christensen Essendon, from Hertfordshire, said: 鈥淚 was diagnosed with bladder cancer and after a course of chemotherapy it was suggested that I have my bladder removed. Under Professor John Kelly I underwent robotic surgery to remove my native bladder which was replaced with a new bladder made out of bowel. The operation was a success, and I was up and walking soon after surgery. Having had the operation in April I was back to work and the gym in the middle of June. I have gone on to lead a normal active life and am eternally grateful to Prof Kelly and his team for their care and support.鈥�

The trial took place from March 2017 to March 2020 and involved 29 surgeons at听nine UK hospital trusts namely; University College London Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust,听Guys and St Thomas鈥� NHS Foundation Trust, NHS Greater Glasgow and Clyde, Royal Berkshire NHS Foundation Trust, St James University Hospital Leeds, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Devon and Exeter NHS Trust, and North Bristol NHS Trust.

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• UCL Surgery & Interventional Science

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• 'Surgical room听with robotic technology equipment' credit Vadym Terelyuk on

Media contact听

Henry Killworth

Tel: +44 (0) 7881 833274

E: h.killworth [at] ucl.ac.uk

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