Top prostate cancer doctor marks incredible milestone of 3,000 robotic ops

A leading prostate cancer surgeon has marked the incredible milestone of performing 3,000 robotic radical prostatectomy operations – and issued a stark warning for the NHS about the profession’s future.

Declan Cahill, head of urology at The Royal Marsden Hospital in London, began using transformative robotic assistance technology two decades ago.

The consultant surgeon told the Express he loves his job and remembers every one of his patients. But he warned that pressure on the health service means it often “feels like you’re running a 10,000 metre race at a 5,000 metre pace, and you get worn down”.

Mr Cahill, 56, said: “There is a significant risk of burnout and early retirement across the board. You need experienced, mature, having-gone-through-the-fight surgeons to help mentor new surgeons.

“We need to allow people to carry on being extremely productive and make it attractive and enjoyable for them to do so. Across the country, most doctors and surgeons are working jolly hard, they’re whacked and you’ve got a morale issue.”

A radical prostatectomy involves removing the entire gland, usually because it is causing an obstruction or is cancerous. This can be done during open surgery or a keyhole procedure where surgical tools are inserted through a small incision.

Robotic-assisted keyhole surgery involves a “master-slave” system where a surgeon controls the movement of a robot wielding the equipment.

Studies have shown that the precise controls and better view of the surgical site means patients often suffer less blood loss and pain, and recover faster after robotic operations.

They also reduce physical strain on the surgeon and can prevent musculoskeletal problems caused by years of bending over the operating table.

Mr Cahill started using the techology in 2003. He said: “The instruments are attached to the robot, the robot has a camera and so the main advantage is that the camera is brilliant. It’s a 3D camera, one for each eye, so at the console I get a 3D image.

“It’s easier to spatially position yourself around the organ and important structures. In the pelvis, it’s often difficult to see things because your hands are in the way, it’s a narrow cavity and getting light is difficult.”

Mr Cahill has progressed from performing 32 radical prostatectomies in his first year to 250 last year. And his work is continually evolving thanks to the vast amount of data he has collected.

He added: “The reason I know I’ve done 3,000 is I enter every patient’s data – hospital number, date of birth, all their cancer specifics, pathology outcomes, follow up – into a database. I’ve done it since my first case on the 24th of April 2003.

“I probably spend on average four hours a week playing with the data and planning how next week is going to be better than last week.”

The medic has used the leading da Vinci robotic system since 2004 and says improvements in the hardware are becoming more marginal over time.

Researchers are now looking to artificial intelligence to aid surgical decision-making and exploring how to integrate complex imaging into live surgeries.

Mr Cahill said he hoped that in the future, doctors will also be able to better predict which prostate cancer patients can be managed with a watch-and-wait approach, sparing them unnecessary surgeries.

But he warned that the vast experience of senior surgeons will remain vital for training the next generation. Two doctors whose teaching was hugely influential on his own career continued teaching into their 90s, Mr Cahill said.

He added: “Keeping surgeons working effectively for as long as possible is very important. The solution to the NHS is the people within it.”