Robotic Gynaecological Surgery in NHS England and Staff Experiences in Robotic Theatres

The rapid adoption of robotic surgery worldwide has been attributed to its perceived surgical and patient benefits. Little attention however has been given to the effect of introduction of a new technology, surgeon-team separation, or the large-sized equipment on staff experiences and theatre dynamics.

The first aim of this thesis was to review the uptake and outcomes of robotic gynaecological surgery in England (2006-2018) based on Hospital Episodes Statistics. 527,217 elective gynaecological procedures were performed, 4384 (0.83%) of which were performed robotically. There was a gradual rise in the uptake of robotic surgery overall, but marked geographical variation across England. Clinical outcomes were comparable to those reported in other countries.

My second aim was to explore staff experiences in robotic theatres using semi-structured interviews and participant observations. Robotic procedures were observed at two tertiary hospitals and laparoscopic/ open procedures were added for comparison. Observation field notes were taken contemporaneously and the interviews were audio recorded and transcribed verbatim. Qualitative analysis was conducted via grounded theory approach using NVIVO12. Twenty-nine participants were recruited to the study and 134 hours of observation were completed across urology, gynaecology and colorectal surgery.

Data analysis identified major concepts pertaining to the robotic team, theatre environment and staff emotions. Higher conceptual analysis proposed a “Robotic Proficiency Theory”, where major elements pertaining to quality patient care included collaborative supportive leadership, the robotic team, robotic processes and optimal robotic performance. While this theory may also apply to other surgical settings, its elements are particularly important within the robotic setting due to the introduction of new technology, surgeon-team separation and large-sized equipment.

Clinically, the proposed model sets a framework to guide introduction or assessment of a robotic surgical programme. From a research perspective, this model will need to be tested within other settings utilising the newer robotic platforms.