Lives transformed by new robotic surgery

Surgeons at Guy’s Hospital have become the first in the world to routinely perform a new type of robotic surgery which transforms the lives of patients at risk of kidney failure.

Patients with the condition retroperitoneal fibrosis (RPF) can develop kidney failure if it is left untreated because scar tissue forms around their ureters (the tubes which pass urine from the kidneys to the bladder), blocking them from working. The condition affects men and women of all ages and is relatively uncommon.

Urological surgeons are using Guy’s and St Thomas’ two da Vinci surgical robots to treat patients in a pioneering procedure, known as robotic ureterolysis. Surgeons use the robots to snip away at the scar tissue with accuracy and precision, freeing the tubes from the scar tissue. This relieves the blockage and allows the tubes to drain properly. Guy’s is the only centre to offer the procedure routinely within one of the largest RPF services in the world.

The new procedure is one of the latest additions to Guy’s robotic surgery programme. Guy’s and St Thomas’ carries out the most robotic operations in the UK with around 450 cases a year. Robotic surgery is already commonly used for prostate, bladder and kidney removal at the Trust.

During a robotic procedure, surgeons control the robot’s four arms from a console in the same room. They look down a small camera on the end of one arm to see inside the patient and the machine gives them a 3D HD view while they operate, eliminates tremor and provides an increased range of movement.

Patients with RPF are usually treated with long-term stents (internal tubes), which are inserted into the ureters to stop the tubes getting blocked. However, these stents can irritate the bladder, cause blood in the urine and make patients constantly need the toilet. The stents need to be changed every six months and can significantly affect the patients’ quality of life. The stents may not provide ideal drainage of the kidneys resulting in progressive loss of kidney function.

Ms Archie Fernando, consultant urological surgeon at Guy’s and St Thomas’, said: “We have carried out the robotic procedure on nearly 40 patients and are very excited about the results. After the surgery patients are able to have the stents removed and their kidneys are able to drain well, which can have a huge positive impact on their lives.

“Ureterolysis can be performed by open surgery too, but patients typically need to stay in hospital for a week afterwards, compared with one or two days after the robotic procedure. They experience less pain and blood loss is also reduced when using robotics, probably because the equipment gives surgeons 3D vision which allows better identification of the space between the ureters and the scar tissue so we can make incisions in exactly the right place, increasing precision and reducing risks.

“All removed scar tissue is preserved for research into RPF, with the patients’ consent, and we are the only place worldwide to collect these samples in a dedicated retroperitoneal fibrosis biobank.”

Terry Iddenden was one of the first patients to benefit from the innovative procedure. He suffered from severe pains in his upper abdominal area before being diagnosed with RPF nearly two years ago and had stents inserted.

Terry, a 49-year-old father of two from Chichester in West Sussex, said: “I hated having the stents – they made me pass blood and they would irritate my bladder so I’d need the toilet constantly. I felt like an old man needing to get up to use the loo seven or eight times a night. They were extremely uncomfortable so I became irritable, which affected my partner Simone too.”

After researching the condition online he read about the services offered at Guy’s and St Thomas’ and arranged to have an appointment. Terry, a trainer, was told about the robotic procedure and underwent tests to find out if he was suitable for it.

He said: “I wanted to get rid of the stents and stop the condition progressing without having open surgery so it sounded like a fantastic option. I am self-employed so a faster recovery also appealed to me.”

Terry had the procedure last August and four weeks later, once tests showed he was healing well, had his stents removed. He said: “Being able to function without having to plan your life around toilet routes is amazing. After two very hard years with stents it was fantastic to get rid of them and I’ve had no problems since the operation.

“The doctors and nurses at Guy’s were superb. They made me feel reassured, kept me and Simone well informed from start to finish and advised me to have a treatment that’s changed my life. I’d recommend it to anyone in my position.”