Findings About Dostarlimab, A New Antibody Drug, Very Encouraging, Says Expert In Cancer Treatment

According to New York Times, in a small clinical trial, 18 patients took a drug called Dostarlimab for around six months, and in the end, every one of them saw their tumours disappear. The findings concerning dostarlimab, an antibody drug, in experimental treatment of rectal cancer patients is very encouraging but there is need for long-term studies to understand the real impact, an expert in cancer treatment has said.

“This new trial at MSKCC in a small number of patients, with locally advanced rectal cancer patients who had MMR (MisMatch repair) deficiency, have shown total disappearance of tumour without any additional treatment in all 100 percent of them. This is very encouraging but we must note that long term studies are required to understand the real impact,” Dr. (Col.) R. Ranga Rao, Chairman, Oncology, of Paras Hospitals in Gurugram said.

“The drug is still investigational and the trial is limited to patients of a specific type , that constitute about 4 to 5 per cent of rectal cancers. While this is highly encouraging, we must not prematurely jump to conclusions that we have found a cure for all cancers, all stages, and no chemotherapy, surgery is ever required,” he added.

He said it is well recognized that Immunotherapy with PDL 1 blockers in MMRd patients is effective. “Already immunotherapy has made a big difference in the field of cancer of all types. Several earlier trials have shown encouraging responses,” Dr Rao said.

In what appears to be a miracle and ‘first time in history’, a small clinical trial has found that every single rectal cancer patient who received an experimental treatment found that their cancer had vanished.

According to New York Times, in the small clinical trial conducted by Memorial Sloan Kettering Cancer Center, 18 patients took a drug called Dostarlimab for around six months, and in the end, every one of them saw their tumours disappear. Dr Luis A. Diaz J. of New York’s Memorial Sloan Kettering Cancer Center (MSKCC) said this was “the first time this has happened in the history of cancer”.

According to experts, Dostarlimab is a drug with laboratory-produced molecules and it acts as substitute antibodies in the human body. The cancer is undetectable by physical exam; endoscopy; positron emission tomography or PET scans or MRI scans, added Experts. This proves that Dostarlimab can be a ‘potential’ cure for one of the most deadly common cancers.

According to New York Times, patients involved in the clinical trial earlier underwent treatments such as chemotherapy, radiation, and invasive surgery that could result in bowel, urinary, and even sexual dysfunction. The 18 patients went into the trial expecting to have to go through these procedures as the next step. However, to their surprise, no further treatment was needed.

The findings of this trial have shocked experts and they have pointed out that complete remission in every single patient is “unheard-of”. Dr Alan P. Venook, who is a colorectal cancer specialist at the University of California, said that the complete remission in every single patient is “unheard-of”. He hailed the research as a “world-first”. Experts stated that the research was impressive as not all of the patients suffered significant complications from the drug trial.

Critics:

Tesaro, a biotech company based out of Massachusetts developed the drug. Tesaro was acquired by GlaxoSmithKline in 2019, dostarlimab is also known by the brand name Jemparli. Dostarlimab was developed to treat women with recurrent or advanced endometrial cancer.

On August 17, 2021, the FDA approved dostarlimab-gxly (brand name Jemperli) for adult patients with mismatch repair-deficient recurrent or advanced solid tumours, as determined by an FDA-approved test, that have progressed on or following prior treatment and who have no satisfactory alternative treatment options.

Rectal cancer remission

According to reports, 18 patients in the clinical trial took Dostarlimab for around six months and after over 12 months the doctors found that their cancer disappeared. While it’s a small trial so far, the results have been impressive; they were published in The New England Journal of Medicine and featured at the nation’s largest gathering of clinical oncologists in June 2022.


In every case, rectal cancer disappeared after immunotherapy — without the need for the standard treatments of radiation, surgery, or chemotherapy — and cancer has not returned in any of the patients, who have been cancer-free for up to two years.

It’s incredibly rewarding to get these happy tears and happy emails from the patients in this study who finish treatment and realise, ‘Oh my God, I get to keep all my normal body functions that I feared I might lose to radiation or surgery,’ expressed Dr Andrea Cercek, Medical Oncologist, Memorial Sloan Kettering Cancer Center (MSK).

Dr Cercek added, “The most exciting part of this is that every single one of our patients has only needed immunotherapy. We haven’t radiated anybody, and we haven’t put anybody through surgery.” She continued, “They have preserved normal bowel function, bladder function, sexual function, fertility. Women have their uterus and ovaries. It’s remarkable.”

This clinical trial could pave the way for treating other forms of cancer in the future. As the trial continues at MSK, Dr Luis Alberto Diaz, Medical Oncologist, Memorial Sloan Kettering Cancer Center (MSK) said, “It’s the tip of the iceberg.” He explains, “We are investigating if this same method may help other cancers where the treatments are often life-altering and tumours can be MMRd. We are currently enrolling patients with gastric (stomach), prostate, and pancreatic cancers.”

Dostarlimab clinical trial reception by the Indian medical community

Since the trial results have been published, it has created a lot of buzz and has got the entire medical community discussing how it could pave the path for future treatment for various cancers, ETHealthWorld spoke to few experts on the drug trial. Commenting on the trial, “It is definitely a big step towards efficient cancer care. The preliminary data on Dostarlimab PD1 monotherapy has been very encouraging in high-risk rectal cancer patients and has been recently presented at the ASCO meeting in Chicago and subsequently published in NEJM.

We would definitely need further studies on larger groups of patients across the globe to establish it as a standard of care for rectal cancer. Trials are also being conducted to study its effectiveness for cervical cancer, and endometrial cancer amongst others,” said Dr Pankaj Kumar Panda, Senior Research Officer, Apollo Proton Cancer Centre.

Source: Findings about Dostarlimab, a new antibody drug, very encouraging, says expert in cancer treatment

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Planning For Surgery? You Might Not Need All Those Tests Beforehand

Let’s say you’re scheduled for a common and relatively low-risk operation, like a cataract removal, hernia repair or a hip or knee replacement. It’s normal to feel anxious about any upcoming surgery.

But what if one of the presurgical tests your doctor orders — for example, a chest X-ray or cardiac stress test — turns up something unexpected, like a suspicious nodule or a mild heart abnormality? Now you have even more reason to worry, and your surgery will likely be delayed until further tests assure the doctor it would be safe to operate.

Experts say that presurgical testing is often unjustified for many common operations. Many of these tests are a waste of time and money, a growing body of research shows, and the tests themselves can sometimes result in complications.

For more than two decades, experts in various medical specialties, including cardiology, ophthalmology and anesthesiology, have issued guidelines directed at reducing preoperative tests that rarely provide findings relevant to a patient’s surgical risk. Yet practicing doctors often do not follow this advice.

Guidelines published in 2002, for example, from the American College of Cardiology, the American Heart Association and the American Society of Anesthesiologists resulted in almost no change in doctors’ presurgical orders nearly a decade later, according to a report in JAMA Internal Medicine. The only exception was a decline in the use of electrocardiograms, or EKGs, a noninvasive test that checks heart function at rest.

Sometimes a preoperative test of questionable value results in unanticipated complications, as happened to a man in his 50s scheduled for repair of a very painful hernia. Two Colorado doctors reported in 2014 that the man’s lab tests and physical exam were normal. But a chest X-ray, ordered because he had a history of mild asthma, suggested he had a nodule on a lung.

Doctors delayed the surgery until he got a CT scan, which did not confirm a lung nodule but did find one on an adrenal gland. Again, doctors postponed surgery to allow for further work-up of the adrenal nodule, which was ultimately found to be benign. The man finally had his hernia repaired after six additional months of debilitating pain and repeated anxiety over incidental test findings suggesting he could have cancer.

However, doctors are making some headway. In 2019 in JAMA Internal Medicine, Dr. John N. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and his colleagues described an effort to reduce “low-value preoperative care” for patients about to have cataract surgery. New guidelines were issued, and a specially trained quality improvement nurse advised the surgeons about the new recommended protocol.

The result, as assessed in a controlled clinical trial of 1,054 patients, was a dramatic decline in preoperative testing, a significant projected cost saving after the first year and “no measurable adverse effects” on the patients’ surgery, he said.

Perhaps most problematic among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physicians’ responses to preoperative guidelines, said in an interview, “Cardiac stress testing is over-ordered. If there’s no indication of a heart problem, like shortness of breath, there’s no reason to do this test prior to surgery.”

The latest guidelines, which the American College of Cardiology and American Heart Association issued in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients lacking symptoms suggestive of heart disease. The guidelines leave the decision to test up to the doctor, and you might think it’s better to rule out a possible heart problem before surgery.

But existing evidence shows no health or lifesaving benefit from a preoperative stress test when the patient lacks cardiac symptoms or has fewer than two major risk factors for having a heart attack, like high blood pressure and smoking, especially when the prospective surgery itself is low-risk.

Yet despite these guidelines and a national campaign called Choosing Wisely, aimed at curbing unnecessary tests and procedures, a recent study by Dr. Daniel S. Rubin and his colleagues at the University of Chicago found that many doctors persist in ordering preoperative stress tests among patients at very low risk for cardiac complications. The study, published in JAMA Cardiology in January, looked at more than 800,000 patients having a hip or knee replaced, which is usually considered a low-risk surgery.

It found that nearly half the patients who were given a preoperative stress test had no cardiac risk factors that might justify its use. Furthermore, the stress test did not lessen the risk of suffering a heart attack or cardiac arrest during or immediately after surgery, even among patients with one or more cardiac risk factors.

In fact, the stress test might have been counterproductive. For reasons Dr. Rubin could not explain, patients without risk factors who were given a cardiac stress test had double the surgical complication rate experienced by comparable patients who did not have one.

Whatever the explanation for that finding, testing itself is not free of risk, as noted by Dr. Ravi Chopra, a resident in neurology at Washington University School of Medicine. In JAMA Internal Medicine in October, Dr. Chopra and his colleagues described a 72-year-old patient with no known cardiovascular disease or cardiac symptoms who was given a stress test before a hip replacement. The test showed a mild heart abnormality, prompting a catheterization that resulted in damage to two blood vessels that then had to be surgically repaired.

“Testing can cause harm,” Dr. Chopra said. “We need to think hard about whom we’re testing. There should be a really good reason.”

Experts suggest you’d be wise to ask whether the prescribed tests would reveal anything relevant to your surgical risk that the doctor could not determine by asking you a few questions during a routine physical. For example, answering a simple question like, “Do you get out of breath climbing a flight of stairs or walking four city blocks?” might provide a quick assessment of whether you might be having heart symptoms.

Dr. Mafi added that “it’s hard to change physician behavior with guidelines,” especially when doctors fear being sued if something goes wrong that might have been prevented by a presurgical test. He suggested that patients can help by questioning what a particular test might show and whether it’s really needed. Also helpful, he said, is to choose a doctor “who’s thoughtful, takes time to listen and is judicious about testing. You don’t have to order 100 tests if just one test will do.”

Portrait of Jane E. Brody

 

Jane E. Brody is the Personal Health columnist for The New York Times, a position she has held since 1976. Ms. Brody’s widely read and quoted column, which appears in The Times’s Science Times section and in scores of other newspapers around the country, earned her the title of “High Priestess of Health” from Time magazine.

Source: Planning for Surgery? You Might Not Need All Those Tests Beforehand. – The New York Times

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How To Choose The Right Employee Benefits For 2022 During Open Enrollment

For employees, it’s not pumpkin spice season right now, it’s Open Enrollment season. That means it’s time to make the health and retirement plan choices that will be right for you in 2022.

It isn’t easy, and many workers feel uneasy about choosing wisely. In its 2021 State of Work in America survey of 1,500 U.S. employees, the professional services firm Grant Thornton found that 36% of workers weren’t confident they’d chosen the best medical plan. And 80% of employees surveyed by Lincoln Financial said they wish they better understood some aspect of their retirement plan.

Employees can expect to see rising out-of-pocket health costs through their employer coverage in 2022, including premium increases of 4% to 5%. Some higher-paid workers will be asked to pay more for their health insurance than lower-paid workers. Roughly a third of employers surveyed by the benefits consulting firm Willis Towers WLTW +0.1% said they’d consider narrowing the network of doctors and other health care providers available to patients.

But you may be in for a few pleasant surprises.

“As employers continue to compete for talent, many are adding a number of new benefits to their lineup for next year including resources and additional paid leave for caregivers, surgery Centers of Excellence [more on this below], financial planning and expanded mental health benefits, virtual physical therapy and other digital health programs,” says Erin Tatar, senior vice president of workplace consulting at Fidelity Investments.

Some employers have added an emergency savings account option through payroll deductions, too. About 23% of employees are currently offered one, according to the Employee Benefit Research Institute.

Tatar’s advice: “Take time to attend virtual benefits fairs to review the growing list of health, wealth and other benefits from your employer this fall.”

Getting the Right Health Coverage

For many older workers, access to affordable health care coverage is the No. 1 employee benefit they seek. Before you enroll in a health plan for 2022, ask yourself: How much did I pay in premiums this year? How many trips to the doctor, hospital or emergency room did members of my household make? What else did we spend out-of-pocket for health care in 2021?

Then, start comparing the features and prices of your options, since they can vary significantly. Compare the benefits, rules, restrictions and costs such as co-pays, annual deductibles and out-of-pocket maximums. You may well need to deal with Alphabet City, deciding among a high deductible health plan (HDHP) with a health savings account or HSA (an HSA lets you save money in a tax-advantaged account and then withdraw cash tax-free to pay for qualified medical expenses), a health maintenance organization (HMO) plan and a preferred provider organization (PPO) plan.

Don’t assume that whatever health plan and benefits you had in 2021 will be the best for you in 2022. Your plan may have changed. Your circumstances may have changed; for example, if your last son or daughter is now in college, it might make sense to buy a university plan for that child while you and your spouse change from family coverage to “employee + 1” coverage.

And don’t miss out on the panoply of health benefits in your plan choices, especially new benefits that can save you money.

“An often-overlooked benefit for older workers is a surgery Centers of Excellence program,” says Tatar. Here, if you are planning to have surgery — such as spine, knee, hip or bariatric surgery — the company will arrange for you to receive care from a Center of Excellence to receive top notch and affordable treatment.

“They will often provide more generous benefits coverage for patients who participate and will cover any upfront travel costs for you and a companion if the best care is outside your community,” Tatar notes.

If you’re in good health, says Seth Mullikin of Lattice Financial in Charlotte, N.C, “an HSA (with a high deductible plan) generally makes sense. From a financial planning perspective, it gets better if you can fund these costs from personal savings and let your HSA money grow tax-free over time.”

The HSA also lets you pay for health expenses in the future, even into retirement, adds Mullikin. In 2022, employees with high-deductible health plans will generally be allowed to contribute up to $3,650 in an HSA; as much as $7,300 for family coverage.

Time for a Second Opinion?

You may also be able to sign up to get a second opinion as part of your health coverage. Some employers have even expanded eligibility to receive a second medical opinion for an employee’s parents and grandparents.

“As we get older, the risk of having a serious health event increases. If this happens to you, it’s natural to seek a second opinion. Some employers we are working with now want to give employees better peace of mind, so they offer ‘second opinion’ benefits,” notes Tatar. “Then they can provide an entire medical diagnosis and treatment plan as an option for you to discuss with your doctor. And it is usually covered one hundred percent.”

Mental Health Coverage

The pandemic and revelations by star athletes including tennis’ Naomi Osaka and gymnastics’ Simone Biles, has made taking care of our mental health a priority.

More than three-quarters of large employers surveyed by the nonprofit Business Group on Health say access to mental health care is now a top priority. In 2021, 62% of employers this group surveyed added mental health benefits.

To that end, check to see if your employer is incorporating resiliency and mindfulness training and mental health options such as telehealth counseling into its benefits offerings.

Disability Coverage

You may also want to look into getting disability insurance coverage through work.

“Your chance of being disabled is much greater than the risk of premature death,” says wealth adviser Graham Ewing of Financial Consulate in Hunt Valley, Md. “If your employer is offering disability insurance, consider it.”

But, he adds, “you need to understand how disability is being defined by the insurance company. For example, some policies will pay out benefits for only two years if you can’t do your current job. Others won’t pay beyond two years if you are not completely incapacitated. So, find out what’s covered and what’s not.”

Group disability coverage typically pays up to 60% of salary if you can’t keep working at your job or switch to another position and you expect to be disabled for a year or more.

Care Giving Benefits

If you are caring for an aging loved one or someone with a serious illness, inquire about work/life balance or employee assistance programs. Some companies are now offering caregiver navigation benefits which connect you with experts to help find local elder care resources or options for assisted living or nursing homes.

If you’re a caregiver, you’ll likely need some give and take with your schedule, so see what HR will do for you.

Says Tim Glowa, a principal and leader of Grant Thornton’s employee listening and human capital services offerings: “Everyone has a unique set of responsibilities outside of the office. As companies return to the office, it will be more crucial than ever to give people the time they need to take care of what’s important at home.”

Financial Wellness and Retirement Planning

Open Enrollment season may also be a good time to revisit your retirement plan and do a “financial check-up,” similar to getting an annual wellness physical from your doctor, says Ewing.

“You may want to revisit your risk tolerance, especially if you are concerned about gyrations in the stock market,” he adds.

Mullikin notes that many of his 50+ clients are worried about having enough money to retire comfortably. “So, our first order of business is to find out if they can increase, or max out, their 401(k) contributions,” he says.

Another way to save more for retirement when you’re over 50 is to make catch-up contributions to your retirement plan.

These let you put in up to $6,500 more than others can in a 401(k) or 403(b) plan or up to $1,000 in an Individual Retirement Account. “Plus, you and your spouse (if they are also enrolled) can make catch-up contributions of up to a thousand dollars to your HSA at age fifty-five,” notes Mullikin.

Reimbursing Your Remote Work Expenses

If you’ll be working remotely in 2022, even part of the time, check with your HR department about getting reimbursed for home office expenses like a standing desk, a Wi-Fi extender, a headset and any ergonomic equipment designed to keep you healthy and productive.

About a fifth of employers the benefits consulting firm Mercer surveyed said they’d be adding or enhancing reimbursement for off-site workers in 2021, including subsidizing ergonomic furniture.

Some firms pay for setups of $200 to $300. Others offer partial ongoing reimbursement for an employee’s home internet service and cell service.

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Next Avenue is public media’s first and only national journalism service for America’s booming older population. Our daily content delivers vital ideas, context and…

Source: How To Choose The Right Employee Benefits For 2022 During Open Enrollment

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490 (2008) Employee Travel – A tax and NICs guide for employers

Robotic Prostatectomy Surgery

Also known as robotic prostatectomy, this minimally invasive procedure is performed with the assistance of advanced surgical technology and an experienced laparoscopic surgery team.

Robotic-assisted radical laparoscopic prostatectomy is accomplished using the da Vinci® Surgical System, a sophisticated robotic surgery system that allows surgeons to operate on the prostate with enhanced vision, control and precision.

Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patient’s abdomen to allow the surgeon to remove the prostate and nearby tissues with great precision. This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.

During robotic-assisted radical prostatectomy, a three-dimensional endoscope and image processing equipment are used to provide a magnified view of delicate structures surrounding the prostate gland (e.g., nerves, blood vessels and muscles), allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.

For most of the surgery, the surgeon is seated at a computer console and manipulates tiny wristed instruments that offer a range of motion far greater than the human wrist. The surgery is performed without the surgeon’s hands entering the patient’s body cavity.

Benefits of Robotic Surgery

Compared with traditional open surgery, patients who undergo robotic-assisted radical prostatectomy experience:

  • Less blood loss
  • Less pain
  • Shorter hospital stays
  • Faster recovery times (although catheter needs to remain in bladder for same amount of time after robotic or open procedure).

Risks of Robotic-Assisted Laparoscopic Radical Prostatectomy

The potential risks of robotic-assisted laparoscopic radical prostatectomy include the following:

  • Bleeding
  • Infection at the surgical site
  • Adjacent tissue/organ damage

Side Effects of Robotic-Assisted Laparoscopic Radical Prostatectomy

The rates of major side effects from robotic-assisted laparoscopic radical prostatectomy are about the same as open surgical approaches. The most common side effects include the following:

  • Urinary incontinence (inability to control urine): Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
  • Erectile dysfunction (impotence): The return of erectile function following prostatectomy is based on the patient’s age, degree of preoperative sexual function and whether the nerves were spared during surgery. Unless cancer is suspected in the nerve tissue, surgeons will use nerve-sparing techniques during robotic prostatectomy to minimize the surgical impact on sexual function.

Prostate Cancer: When to Treat Versus When to Watch

Because certain prostate cancers grow very slowly, your doctor might determine that it’s not likely to present a significant threat to you. This is particularly true if a prostate cancer is localized, meaning it hasn’t spread beyond the prostate.

If that’s the case, you and your doctor can discuss getting regularly tested instead of undergoing treatment right away. Doctors call this approach active surveillance. By not rushing into treatment for a cancer that may not cause you any harm, this approach helps many men avoid treatment-related side effects.

Active surveillance , or active monitoring, means your doctor will monitor you closely, watching to see how the cancer progresses, if at all. This is primarily for cancers that doctors classify as:

  • Slow-growing
  • Very low risk for causing symptoms

To monitor a low-risk prostate cancer, someone on active surveillance could undergo:

  • Rectal exam : Every six months
  • PSA test : Twice a year. This blood test, commonly used to screen for prostate cancer, measures how much prostate-specific antigen (PSA) is in your blood.
  • Biopsy : Once a year (until and unless your doctor determines a less frequent biopsy is warranted)
  • MRI scan : Necessary in some cases to show more details of a cancer if your doctor has any questions or concerns from your test results

Prostate Cancer Treatment: When Watching May Be Enough

Your doctor will consider many factors before deciding whether this approach is right for you. This includes:

  • Gleason score : This scoring system grades how aggressive a prostate cancer is. It also gives doctors hints as to how likely a cancer is to spread. Gleason scores less than 7 are considered lower risk and might be appropriate for active surveillance.
  • Biopsy results : A prostate biopsy (removing tissue samples from the prostate) is the only definitive way to diagnose prostate cancer today. After a prostate biopsy, your doctor will count how many of the samples contain cancer. For biopsies that show three or fewer samples (or cores) with cancer, your doctor might recommend watching you before starting treatment.
  • PSA results : A PSA test is the standard way doctors assess prostate cancer risk. Doctors use PSA test results along with information about your prostate size to measure your PSA density. If PSA density is less than 0.15, you might not need treatment right away.
  • Physical characteristics : Another way your doctor will assess prostate cancer is through a rectal exam. If he or she can’t feel a cancer (via a hard nodule, for example), that’s another sign that could point to active surveillance as a possible treatment approach.

Source: Robotic Prostatectomy | Johns Hopkins Medicine

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This 3d medical animation provides an overview about the anatomy of the male urogenital system, with the main focus on the prostate. Prostate cancer is shown developing in the tubular ducts of the prostate. All of the general steps are then demonstrated in the animation to show how the cancerous prostate will be robotically removed during a minimally invasive procedure.

The Robot Will See You Now: Could Computers Take Over Medicine Entirely – Tim Adams

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Like all everyday miracles of technology, the longer you watch a robot perform surgery on a human being, the more it begins to look like an inevitable natural wonder.

Earlier this month I was in an operating theatre at University College Hospital in central London watching a 59-year-old man from Potters Bar having his cancerous prostate gland removed by the four dexterous metal arms of an American-made machine, in what is likely a glimpse of the future of most surgical procedures.

The robot was being controlled by Greg Shaw, a consultant urologist and surgeon sitting in the far corner of the room with his head under the black hood of a 3D monitor, like a Victorian wedding photographer. Shaw was directing the arms of the remote surgical tool with a fluid mixture of joystick control and foot-pedal pressure and amplified instruction to his theatre team standing at the patient’s side. The surgeon, 43, has performed 500 such procedures, which are particularly useful for pelvic operations; those, he says, in which you are otherwise “looking down a deep, dark hole with a flashlight”.

The first part of the process has been to “dock the cart on to the human”. After that, three surgical tools and a video camera, each on the end of a 30cm probe, have been inserted through small incisions in the patient’s abdomen. Over the course of an hour or more Shaw then talks me through his actions.

“I’m just going to clip his vas deferens now,” he says, and I involuntarily wince a little as a tiny robot pincer hand, magnified 10 times on screens around the operating theatre, comes into view to permanently cut off sperm supply. “Now I’m trying to find that sweet spot where the bladder joins the prostate,” Shaw says, as a blunt probe gently strokes aside blood vessels and finds its way across the surface of the plump organ on the screen, with very human delicacy.

After that, a mesmerising rhythm develops of clip and cauterise and cut as the velociraptor pairing of “monopolar curved scissors” and “fenestrated bipolar forceps” is worked in tandem – the surprisingly exaggerated movements of Shaw’s hands and arms separating and sealing tiny blood vessels and crimson connective tissue deep within the patient’s pelvis 10ft away. In this fashion, slowly, the opaque walnut of the prostate emerges on screen through tiny plumes of smoke from the cauterising process.

This operation is part of a clinical trial of a procedure pioneered in German hospitals that aims to preserve the fine architecture of microscopic nerves around the prostate – and with them the patient’s sexual function. With the patient still under anaesthetic, the prostate, bagged up internally and removed, will be frozen and couriered to a lab at the main hospital site a mile away to determine if cancer exists at its edges. If it does, it may be necessary for Shaw to cut away some of these critical nerves to make sure all trace of malignancy is removed. If no cancer is found at the prostate’s margins the nerves can be saved. While the prostate is dispatched across town, Shaw uses a minuscule fish hook on a robot arm to deftly sew bladder to urethra.

 
‘The technique itself feels like driving and the 3D vision is very immersive’: Greg Shaw controls
the robot as it operates on a patient Photograph: Jude Edginton for the Observer

The Da Vinci robot that Shaw is using for this operation, made by the American firm Intuitive Surgical, is about as “cutting edge” as robotic health currently gets. The £1.5m machine enables the UCH team to do 600 prostate operations a year, a four-fold increase on previous, less precise, manual laparoscopic techniques.

Mostly, Shaw does three operations one or two days a week, but there have been times, with colleagues absent, when he has done five or six days straight. “If you tried to do that with old-fashioned pelvic surgery, craning over the patient, you would be really hurting, your shoulders and your back would seize up,” he says.

There are other collateral advantages of the technology. It lends itself to accelerated and effective training both because it retains a 3D film of all the operations conducted, and enables a virtual-reality suite to be plugged in – like learning to fly a plane using a simulator. The most important benefit however is the greater safety and fewer complications the robot delivers.

I wonder if it changes the psychological relationship between surgeon and patient, that palpable intimacy.

Shaw does not believe so. “The technique itself feels like driving,” he says. “But that 3D vision is very immersive. You are getting lots of information and very little distraction and you are seeing inside the patient from 2cm away.”

There are, he says, still diehards doing prostatectomies as open surgery, but he finds it hard to believe that their patients are fully informed about the alternatives. “Most people come in these days asking for the robot.”

If a report published this month on the future of the NHS is anything to go by, it is likely that “asking for the robot” could increasingly be the norm in hospitals. The interim findings of the Institute for Public Policy Research’s long-term inquiry into the future of health – led by Lord Darzi, the distinguished surgeon and former minister in Gordon Brown’s government – projected that many functions traditionally performed by doctors and nurses could be supplanted by technology.

“Bedside robots,” the report suggested, may soon be employed to help feed patients and move them between wards, while “rehabilitation robots” would assist with physiotherapy after surgery. The centuries-old hands-on relationship between doctor and patient would inevitably change. “Telemedicine” would monitor vital signs and chronic conditions remotely; online consultations would be routine, and someone arriving at A&E “may begin by undergoing digital triage in an automated assessment suite”.

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Even the consultant’s accumulated wisdom will be superseded. Machine-learning algorithms fed with “big data” would soon be employed to “make more accurate diagnoses of diseases such as pneumonia, breast and skin cancers, eye diseases and heart conditions”. By embracing a process to achieve “full automation” Lord Darzi’s report projects that £12.5bn a year worth of NHS staff time (£250m a week) would be saved “for them to spend interacting with patients” – a belief that sounds like it would be best written on the side of a bus.

While some of these projections may sound far more than the imagined decade away, others are already a reality. Increasingly, the data from sensors and implants measuring blood sugars and heart rhythms is collected and fed directly to remote monitors; in London, the controversial pilot scheme GP@Hand has seen more than 40,000 people take the first steps toward a “digital health interface” by signing up for online consultations accessed through an app – and in the process, de-registering from their bricks-and-mortar GP surgery. Meanwhile, at the sharpest end of healthcare – in the operating theatre – robotic systems like the one used by Greg Shaw are already proving the report’s prediction that machines will carry out surgeries with greater dexterity than humans. As a pioneer of robotic surgical techniques, Lord Darzi knows this better than most.Bedside robots will feed patients while others would assist with physio

In a way, it is surprising that it has taken so long to reach this point. Hands-off surgery was first developed by the US military at the end of the last century. In the 1990s the Pentagon wanted to explore ways in which operations at M*A*S*H-style field hospitals might be performed by robots controlled by surgeons at a safe distance from the battlefield. Their investment in Intuitive Surgical and its Da Vinci prototype has given the Californian company – valued at $62bn – a virtual monopoly, fiercely guarded, with 4,000 robots now operating around the world.

Jaime Wong MD is the consultant lead on the R&D programme at Intuitive Surgical. He is also a urologist who has been using a Da Vinci robot for more than a decade and watched it evolve from original 2D displays that involved more spatial guesswork, to the current far more manoeuvrable and all-seeing version.

Wong still enjoys seeing traditional open surgeons witnessing a robotic operation for the first time and “watching the amazement on their faces at all the things they did not quite realise are located in that area”.

In the next stage of development, he sees artificial intelligence (AI) and machine learning playing a significant role in the techniques. “Surgery is becoming digitised, from imaging to movement to sensors,” he says, “and everything is translating into data. The systems have a tremendous amount of computational power and we have been looking at segmenting procedures. We believe, for example, we can use these processes to reduce or eliminate inadvertent injuries.”

Up until recently, Da Vinci, having stolen a march on any competition, has had this field virtually to itself. In the coming year, that is about to change. Google has, inevitably, developed a competitor (with Johnson & Johnson) called Verb. The digital surgery platform – which promises to “combine the power of robotics, advanced instrumentation, enhanced visualisation, connectivity and data analytics” – aims to “democratise surgery” by bringing the proportion of robot-assisted surgeries from the current 5% up to 75%. In Britain, meanwhile, a 200-strong company called CMR Surgical (formerly Cambridge Medical Robotics) is close to approval for its pioneering system, Versius, which it hopes to launch this year.

Wong says he welcomes the competition: “I tend to think it validates what we have been doing for two decades.”

The latest creators of robot surgeons see ways to move the technology into new areas. Martin Frost, CEO of the Cambridge company, tells me how the development of Versius has involved the input of hundreds of surgeons with different soft-tissue specialities, to create a portable and modular system that could operate not just in pelvic areas but in more inaccessible parts of the head, neck and chest.

“Every operating room in the world currently possesses one essential component, which is the surgeons’ arm and hand,” Frost says. “We have taken all of the advantages of that form to make something that is not only bio-mimicking but bio-enhancing.” The argument for the superiority of minimally invasive surgery is pretty much won, Frost suggests: “The robotic genie is out of the bottle.”

And what about that next stage – does Frost see a future in which AI-driven techniques are involved in the operation itself?

“We see it in small steps,” he says. “We think that it is possible, within a few years, that a robot may do part of certain procedures ‘itself’, but we are obviously a very long way from a machine doing diagnosis and cure, and there being no human involved.”A specialist mentor could be looking at different camera views, providing second opinions. It will be like ‘phone a friend’

The other holy grail of telesurgery – the possibility of remote “battlefield” operations – is closer to being a reality. In a celebrated instance, Dr Jacques Marescaux, a surgeon in Manhattan, used a protected high-speed connection and remote controls to successfully remove the gallbladder of a patient 3,800 miles away in Strasbourg in 2001. Since then there have been isolated instances of other remote operations but no regular programme.

In 2011, the US military funded a five-year research project to determine how feasible such a programme might be with existing technology. It was led by Dr Roger Smith at the Nicholson Center for advanced surgery in Florida.

Smith explained to me how his study was primarily to determine two things: first, latency – the tiny time lag of high-speed connections over large distances – and second, how that lag interfered with a surgeon’s movements. His studies found that if the lag rose above 250 milliseconds “the surgeon begins to see or sense that something is not quite right”. But also that using existing data connections, between major cities, or at least between major hospital systems, “the latency was always well below what a human surgeon could perceive”.

The problem lay in the risk of unreliability of the connection. “We all live on the internet,” Smith says. “Most of the time your internet connection is fantastic. Just occasionally your data slows to a crawl. The issue is you don’t know when that will happen. If it occurs during a surgery you are in trouble.” No surgeon – or patient – would like to see a buffering symbol on their screen.

The ways around that would involve dedicated networks – five lines of connectivity with a performance level at least two times what you would ever need, Smith says, “so that the chances of having an issue were like one in a million”.

Those kinds of connections are available, but the lack of investment is more one of regulation and liability than cost. Who would bear the risk of connection failure? The state in which the surgeon was located, or that in which the patient was anaesthetised – or the countries through which the cable passed? As a result, Smith says: “In the civilian world, there are few situations where you would say this is a must-have thing.”

He envisages three possible champions of telesurgery: the military, “If you could, say, create a connection where the surgeon could be in Italy and the patient in Iraq”; medical missionaries, “Where surgeons in the developed world worked through robots in places without advanced surgeons”; and Nasa, “At a point where you have enough people in space that you need to set up a way to do surgery.” For the time being the technology is not robust enough for any of these three.

For Jaime Wong the risks are likely to remain too great. Intuitive Surgical is pursuing the concepts of “telementoring” or “teleproctoring” rather than telesurgery. “The local surgeon would be performing the surgery, while our monitor would be remote,” he suggests, “and a specialist mentor could be looking at different camera views, providing second opinions. It will be like ‘phone a friend’.”

True telesurgery, Roger Smith suggests, also begs a further question, one which we may yet hear in the coming decade or so. “Would you have an operation without a surgeon in the room?” For the time being, the answer remains a no-brainer.

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