What seven years of robotic surgery has achieved in the West Midlands

2 May 2018, Peter Cooke 

Mr Peter Cooke is a robotically trained surgeon at New Cross Hospital in Wolverhampton. Here he shares a little about what his robotic training from The Urology Foundation has meant for him, his team, and his patients.

Photo courtesy of Department of Clinical Illustration, New Cross Hospital, Wolverhampton

I’ve been a part of a successful robotic surgery team in Wolverhampton for seven years now. Together we have been able to provide alternative treatment options to urology patients in the West Midlands and I’m grateful to TUF for enabling us to do this.

What did robotic surgery training look like for us?

Back in 2012 my team and I received a preceptorship from The Urology Foundation. It meant that the four core members of our operating team had the opportunity to receive mentorship from the team at Guy’s Hospital, cadaveric team training in Paris, and the opportunity to visit Vanderbilt University Medical Center in Nashville, USA to learn from their robotic surgery experts.

As you’d expect, we learnt a lot about the specific robotic surgical techniques used there, but learning those alone wouldn’t have set us up particularly well. The team in Nashville run one of the highest volume centres in the USA, with huge numbers of patients coming through their doors each year. They took us through their entire operation; showing us how to organise a team to provide for a high volume of patients, from their nursing process, to their surgical assistants and surgical scheduling, as well as patient assessment and pre-operative counselling.

The catalyst

Having a preceptorship like this one kick-started our work back in Wolverhampton. Before the preceptorship we were doing around 100 laparoscopic (standard key-hole) prostatectomies a year and 20 open cystectomies a year. Now we’re at a position where we’re performing 150 robotic prostatectomies and 20-30 robotic cystectomies annually, and we’ve added a range of new procedures to our repertoire; we’re now able to offer our patients neo-bladder formation, robotic pelvic exenteration, and robotic partial nephrectomies. As our confidence is growing, we are able to take on more high risk cases, such as people who need more wide excision of advanced tumours, or people who are heavier or who have had previous abdominal surgery. 

Our urology department is now in a position where we can do most things robotically, and robotic surgery has become the default option for us. On top of this, the team is expanding with new trainees, surgeons, and surgical assistants, meaning that we can offer a more uninterrupted service for patients across the West Midlands.

Our centre of excellence

When I say that we serve patients from across the West Midlands, I really mean it. After seven years of offering robotic surgery we’re now in a position where we’re receiving referrals from Birmingham, Worcester, Shropshire, and Staffordshire. Not only are we receiving referrals, but patients are requesting to see us as word of mouth spreads about our success rates. We’ve been very good at tracking patients’ outcomes so that now we can tell patients how long we expect them to be with us after the surgery and what surgery might mean for continence and sexual function, in particular. As we’re growing in confidence and experience, we’re able to imbue that confidence and reassurance into our patients.

Given that we have such a high volume of patients, I am incredibly grateful for our experiences in Nashville. We’ve been able to take what we’ve learnt there and make it work for Wolverhampton. Our patient pathways are now well established and we’re seeing excellent results. It’s really shown me that having robotic surgery skills is only half of the story; you need to be able to offer patients the service they need outside of the theatre, as well.                                            

The TUF effect

The service that my team and I offer to people in the West Midlands has come on leaps and bounds thanks to the support we received from TUF and it’s grown sustainably so that the quality of service isn’t compromised by high volume of service. Our experience has also meant that we’ve been able to help other surgeons train in our area; there’s been a ripple effect so that the quality of service hasn’t just improved in our centre, but in centres across the region. A bit of funding for me and my team has had a significant impact on the whole region.

For me personally, as well, having the support of The Urology Foundation has made a big difference as I’ve been able to build relationships with fellow robotic surgeons and other urologists. It’s grown my experience and confidence and has been very rewarding. It’s very reassuring to know there is a charity dedicated to the whole of urology. The team at TUF are genuinely committed to the urology profession, ensuring we have the support we need to provide the best outcome for the patient.

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