A robotic system that promises to improve the quality of 'keyhole' bowel cancer surgery is being put to the test for the first time.
The worldwide trial, led by the University of Leeds, UK, will show whether robotic assistance makes it easier to remove bowel tumours using laparoscopic or 'keyhole' techniques and whether using this approach makes the cancer less likely to come back. The study will also show whether giving surgeons a robotic 'helping hand' means that patients spend less time in hospital after keyhole bowel surgery and suffer fewer complications.
Many operations to remove bowel tumours can now be done using keyhole surgery, during which surgeons use special elongated instruments, inserted through small holes in the abdominal wall, to remove cancers. In the hands of an experienced surgeon, keyhole surgery is just as good as open surgery for curing bowel cancer. Patients who have their tumours removed via keyhole surgery also benefit from shorter hospital stays and faster recovery times.
However, removing a bowel cancer using keyhole surgery is a challenging procedure. Sometimes surgeons have to switch to open surgery mid-way through the operation and make a large cut in the patient's stomach to get to the cancer.
To address this, robotic systems have been developed that can make it easier for surgeons to see and take out bowel cancers using keyhole techniques. These systems let surgeons sit comfortably a few feet away from the patient and watch magnified video images of the operation. Guided by these images, the surgeon then uses precise hand movements to carefully control a set of robotic surgical instruments inside the patient's body to remove the cancer.
Researchers and surgeons now want to find out what difference robotics actually make in practice. To do this, they are comparing what happens to bowel cancer patients who undergo robotic-assisted keyhole surgery against those who have standard laparoscopic surgery.
David Jayne, Senior Lecturer in Surgery at the University of Leeds and Chief Investigator for the ROLARR (Robotic versus Laparoscopic Surgery) trial, said: "It has been very exciting to see the emergence of robotic surgery and I am hopeful that such systems will be of real benefit to patients with bowel cancer. However, it is vitally important that the value of robotic assistance is evaluated properly. Surgeon, patients, and healthcare providers need to know what difference this expensive and specialist technology will make – which is exactly what this study will show."
Professor Julia Brown, Director of the University of Leeds' Clinical Trials Research Unit, said: "We are delighted to be building on our track record in the evaluation of new surgical procedures and to be extending into a worldwide evaluation."
The first patients to take part in this trial of next-generation surgical technology are now being recruited. The study will eventually involve 400 patients in more than 20 centres across Europe, the US and Asia.
The ROLARR trial is being managed by the University of Leeds' Clinical Trials Research Unit (CTRU), part of the University's School of Medicine. The trial is a partnership between the University of Leeds and Leeds NHS Teaching Hospitals Trust.
The work is being financed by a research grant awarded by the Efficacy and Mechanism Evaluation (EME) programme, which is funded by the Medical Research Council (MRC) and managed by the National Institute for Health Research (NIHR). Additional funding support has been provided from the University of Leeds' Biomedical and Health Research Centre (BHRC).
For further information:
Paula Gould, University of Leeds press office: Tel 0113 343 8059, email p.a.gould@leeds.ac.uk
Notes to editors:
1. The ROLARR trial follows on from landmark work in the CLASICC trial, also led by University of Leeds researchers and coordinated through the Clinical Trials Research Unit, that helped change attitudes and practice towards laparoscopic surgery for colorectal cancer. See DG Jayne et al, 'Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer', British Journal of Surgery, 97(11), November 2010. (http://www.bjs.co.uk/details/article/892735/Fiveyear-followup-of-the-Medical-Research-Council-CLASICC-trial-of-laparoscopica.html).
2. One of the UK's largest medical, health and bioscience research bases, the University of Leeds delivers world leading research in medical engineering, cancer, cardiovascular studies, epidemiology, molecular genetics, musculoskeletal medicine, dentistry, psychology and applied health. Treatments and initiatives developed in Leeds are transforming the lives of people worldwide with conditions such as diabetes, HIV, tuberculosis and malaria. http://www.leeds.ac.uk/
The University of Leeds' Clinical Trials Research Unit (CTRU) is one of the largest clinical trials units in Europe with a large portfolio of clinical trials and associated methodological research. Reflecting the quality of its portfolio, the CTRU is a National Cancer Research Institute Accredited and UKCRC Registered CTU.
The Biomedical and Health Research Centre (BHRC) is a formal strategic partnership between the four science Faculties of the University of Leeds and the Leeds Teaching Hospitals NHS Trust. The centre promotes collaboration between basic sciences, translational, clinical and applied health research to create an internationally competitive centre of excellence in research. www.bhrc.ac.uk
3. The Efficacy and Mechanism Evaluation (EME) programme supports later-phase 'science-driven' clinical trials and evaluative studies, which seek to determine whether a health intervention (e.g. a drug, diagnostic technique or device) works and in some cases how or why it works. The Efficacy and Mechanism Evaluation programme (www.eme.ac.uk) is funded by the Medical Research Council and managed by the National Institute for Health Research (NIHR).
4. The NIHR provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
5. The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public's needs. The results have led to some of the most significant discoveries in medical science and benefitted from the health and wealth of millions of people in the UK and around the world. http://www.mrc.ac.uk/