Operating with robots

NHS Golden Jubilee has recently performed its 1,000th robotic orthopaedic joint replacement - HB looks at the hospital’s robotics programme

In November 2019, the orthopaedic team at NHS Golden Jubilee were the first in Scotland to use a Mako robot for routine total and partial knee replacement.
The Golden Jubilee University National Hospital, based in Clydebank, is one of Europe’s largest elective orthopaedic centres. In 2021-22, the centre carried out more than 30 per cent of all elective hip and knee replacements in NHS Scotland.

Using the robots means patients get better implant accuracy, reduced soft tissue damage and reduced blood loss. In the long-term, it also means patients are less likely to need further joint replacements later in life, resulting in benefits for the NHS and the patient themselves. The robots are also helping to cut waiting times.
Talking about the milestone, consultant orthopaedic surgeon Christopher Gee, said: “It’s a huge delight to see that we’ve reached the 1,000th patient milestone and this is an accomplishment of which we should all be very proud.
“This has been a real team effort, from providing more preoperative imaging in radiography to allow us to plan the cases, to the Patient Coordination Centre organising the appointments, the theatre teams learning new equipment all the way to the surgeons carrying out the procedures.
“Having surgery is a huge moment in a patient’s life and we want to give them the best possible chance of a good outcome. A key factor in this is making sure the implants are put in as accurately as possible, ensuring they last as long as possible.
“With this increased accuracy and improved outcomes associated with robotic surgery, the hope is that the joint only needs to be replaced once in a patient’s lifetime.
“While there is of course always the potential of needing further surgery in the future, with this pioneering technology becoming more common and popular among patients, our aim is that this translates to long term and wide spread improved quality of life for patients across Scotland.”

The Mako robot enables the surgeon to implant every joint replacement in the optimal position for each individual patient based on their specific anatomy, while at the same time, reducing bone resection and soft tissue injury.
The robot is able to build a virtual 3D model of the patient’s anatomy based on a pre-operative CT scan, this is then validated by live intra-operative measurements. The surgeon is able to fine-tune the position of each component so that it works best for each patient. The robotic arm is utilised to make precise bone cuts as per the surgical plan. This conserves bone and minimises soft tissue damage.
On the day in December the milestone was reached, John Wishart, 80, from Houston in Renfrewshire, had a partial knee replacement, carried out with the aid of a Stryker Mako robot.
John said: “The pain over the past couple of years has been horrendous, to the point that around last Christmas time I could hardly sleep, so I should get to enjoy Christmas this year without that pain.
“I did a lot of exercise in the gym with a lot of cardio work to prepare for my operation and the physiotherapist has told me that has really helped me post-op, because I don’t need a frame and can get around on sticks at the moment.
“Now that I’ve had this procedure at the Golden Jubilee, I’m looking forward to a full recovery and getting back to the gym.”

Rosa and Da Vinci
The hospital has three robots for orthopaedic procedures – two Mako and one Rosa.

They also have two Da Vinci robots – one for lung and one for colorectal/other procedures.
The Da Vinci robot works by inserting rods into the body which are operated by a surgeon on a separate control pad, which moves the procedure on from conventional keyhole and traditionally invasive surgery. The wristed instruments of the robot have the ability to bend and rotate better than a human hand, with more accuracy as well, which means the surgeon can operate with a steady natural motion.
Patients who received robotic surgery, reported less pain and earlier return to normal activity, as well as a shorter hospital stay. The technology enables patients to recover more quickly, and reduces the chance of complications and nerve damage during the surgery.
The Da Vinci machine also has health benefits for the surgeons involved, as they are able to perform surgery sitting down instead of bending over an operating table. This can prevent back injuries and potentially extend their working life.
NHS Golden Jubilee medical director, Dr Mark MacGregor, said: “It is testament to the hard work and dedication of all the teams involved that we have reached this milestone of treating 1,000 patients with cutting edge robotic technology.
“We now have 5 robots as part of our robotics programme here at NHS Golden Jubilee for orthopaedics, lung cancer, colorectal and other procedures.
“By collaborating with health boards from all across the NHS Scotland, this not only has huge benefits for patients all around the country, but is providing vital support to help tackle waiting lists both now and in the future.”