Eleven robotic surgery systems have been approved for use in the UK, and they hold the potential to transform care for patients undergoing soft tissue and orthopaedic procedures within the NHS.
Patient organisations told an independent appraisal committee at NICE that the biggest benefits of robotic surgery were faster recovery times, shorter hospital stays and a quicker return to work.
Patients reported experiencing reduced pain and scarring compared to traditional surgery.
The 11 systems can be used while further evidence is collected over the next three years, demonstrating their cost-effectiveness for robot-assisted surgery as part of NICE’s Early Value Assessment process.
Five systems for soft tissue procedures – including hernia repair, tumour removal, and gallbladder removal – and six for orthopaedic surgery – such as full and partial knee replacements and hip replacements – have received conditional approval.
The use of robotic systems for prostatectomy falls outside the scope of these two pieces of guidance and is already established practice in the NHS.
The recommendations will allow a coordinated approach to the expansion of innovative surgical technologies so the NHS can maximise the benefits for patients.
Evidence will be collected to assist the NICE committee in validating these benefits, demonstrating the technologies’ value, and informing future implementation decisions.
Dr Anastasia Chalkidou, programme director of NICE’s HealthTech programme said: ‘Robot-assisted surgery may help overcome key limitations of conventional techniques through precise movements and enhanced 3D visualisation, potentially transforming surgical options and outcomes for NHS patients. Both applications could benefit patients who might not otherwise be candidates for minimally invasive approaches.’
Each robot system costs between £500,000 and £1.5 million and is typically found only in specialist centres.
In 2011/12, only 20% of robotic procedures were for conditions other than urological cancer. By 2023/24, this had grown to 49%, with significant expansion in colorectal surgery, which now accounts for 25% of all robotic procedures.
Orthopaedic robot-assisted surgery has seen the fastest rise, growing from approximately 300 procedures in 2018/19 to more than 4,000 last year.
Professor Sir Stephen Powis, NHS national medical director, said: ‘Robot-assisted surgery is crucial to the future of high-quality healthcare – and with benefits including shorter stays in hospital, faster recovery for patients and less invasive procedures, these advancements will have a knock-on effect throughout the system and help patients get treated quicker. This is an important step forward as we continue to work to ensure everyone can get high-quality care when needed.
John McGrath, consultant urological surgeon at North Bristol NHS Trust, and chair of the NHSE Steering Committee for Robotic Assisted Surgery, said: ‘Later this month, we will release the first national guidance for the NHS in England that describes how robotic programmes should be configured, implemented and delivered as the services scale up. A key aspect of this is ensuring the necessary increase in expertise in robot-assisted surgery across the NHS workforce so this technology can have the greatest possible impact for patients.’
The committee noted several important considerations for implementing robot-assisted surgery services. These include ensuring equitable access across different regions, as current evidence shows lower uptake of minimally invasive surgery in more deprived areas of the country.
Additionally, the availability of training, resources and staff to support these services will require careful planning.
Companies must agree to generate evidence outlined in NICE’s evidence generation plans and maintain appropriate regulatory approval, including NHS England's Digital Technology Assessment Criteria (DTAC).
The committee will review both guidance documents, utilising evidence collected over the next three years to decide whether these technologies should be routinely adopted across the NHS.
