Robotic surgery is changing what's possible in gynaecological cancer care - widening access to minimal access surgery, reducing recovery times, and protecting the long-term health of the surgeons who deliver it. Realising its full potential will depend on how we train the next generation of gynaecologists to use it.
This is an important part of the RCOG Surgical Skills Projects mission to deliver practical, evidence-based improvements to surgical training and standards. This project will support the O&G workforce to provide high-quality, evidence-based care now and in the future.
We spoke to Dr Amy Keightley (Consultant Gynaecologist and Gynae Oncology Lead at Great Western Hospital in Swindon) about the real impact of robotics on patients, the barriers to training, and what needs to change.
Q: What difference does robotic surgery actually make for patients?
The biggest shift is who we can now offer surgery to. Endometrial cancer risk rises steeply with obesity - roughly 60% higher risk for every five points of BMI. That means a lot of patients being treated are living with a high BMI, and previously, many of these women would have been offered hormonal treatment rather than surgery, simply because open or laparoscopic surgery carried too much risk.
Robotic surgery has changed that. Patients who once would never have been considered for minimal access surgery can now be offered a surgical option with confidence. It's a hard benefit to capture in a traditional study, because there's often no like-for-like comparison, but we are seeing early benefits around reduction in length of stay and post-operative pain.
Q: Is the benefit only for patients, or does it go further than that?
There are also benefits to the surgeon which often doesn't get talked about. Laparoscopic surgery takes a real physical toll for example shoulder and back injuries are common from years of operating in awkward, static positions. A surgeon represents hundreds of thousands of pounds of training and experience, and losing that experience early to a preventable injury is a real loss to the system.
Robotic platforms let surgeons operate in a more ergonomic position, which can extend careers. That's not a direct patient benefit in the way reduced complication rates are, but it keeps skilled, experienced surgeons operating for longer and that benefits patients over time.
Looking ahead, the next real leap for patient safety will come from technology like real-time anatomical overlays - highlighting the ureter, bladder, and major blood vessels on screen during surgery. That's when we'll start to see a meaningful reduction in injury rates, not just shorter stays and less post-operative pain, which is where the evidence currently sits.
Q: What's stopping robotic training from reaching more trainees?
First, access to the technology itself and there's a clear geographic divide. More robots in the south than the north, more in wealthier areas than deprived ones, more in large hospitals than small ones. Without access to a robot, you don't have training opportunities.
Second, how training is structured. At the moment, trainees are often expected to master the full procedure in open and laparoscopic surgery before they're allowed anywhere near a robotic console. Robotic training should introduce the tool early, and build surgical skill on top of it, under supervision, the same way we already do for every other technique.
Third, robotics is still seen as the domain of complex cancer or specialist endometriosis surgery. If we want to hit national ambitions for robotic-assisted procedures, robotics needs to be embedded in general gynaecology - routine hysterectomies, routine procedures - not reserved for the most complex cases. That's what will create the volume of trained, confident consultants needed to then train the next generation of trainees.
Q: What would actually help fix this?
Earlier exposure in the curriculum, structured hands-on skills training and protected time to deliver that training. Right now, a lot of this training happens on personal time with consultants running courses on weekends, trainees attending in their own time, because there's no funded space in job plans for it.
If we want robotics to reach its full potential for patients - better outcomes, wider access, safer surgery - the investment can't just be in machines. It has to be in the time and structure to train people properly to use them.
ENDS
One of the key themes emerging from the RCOG Surgical Skills Project has been the need to embrace innovation and ensure that O&G training evolves alongside modern surgical practice. Trainees consistently told us they wanted earlier exposure to emerging technologies, clearer training pathways and equitable access to robotic surgery.
In response, the RCOG running two pilot robotic surgery courses in September:
- Discovery Day introducing early-career O&G trainees to robotic surgery - hands-on simulation to provide an introduction to robotic systems, theatre workflow, safety, console skills and future training pathways.
- Robotic Surgery Course for ST5+, SST and robotic SITM trainees - practical simulation to support progression towards supervised robotic surgical practice.
These courses are part of the projects broader aim of helping to develop the future robotic workforce and improve access to advanced minimally invasive surgery for women across the NHS.
Read more about the project: Surgical training skills project | RCOG