The patient was in Gibraltar. The surgeon was in London. The outcome was a remarkable triumph for remote robotic surgery that saved the life of a 62-year-old football fan with prostate cancer.
Inside the operating theatre at St Bernard’s, the only hospital in the British overseas territory, a hi-tech robot with four arms, and fitted with a 3D camera, removed the prostate of Briton Paul Buxton, who moved to Gibraltar 40 years ago.
Performing the procedure 1,500 miles away, from London’s Harley Street district, was Prof Prokar Dasgupta, a professor of urology who heads The London Clinic’s robotic centre of excellence.
With the help of technology services provider Presidio, Dasgupta used a console in London to guide the Toumai Robotic System, made by Microport, through an intricate sequence of steps to successfully give Buxton a prostatectomy, a surgical removal of the prostate.
The procedure went to plan with a lag of only 0.06 seconds between the surgeon in London and the robot in Gibraltar. After his unique experience, Buxton said he felt “fantastic” within days.
Prof Prokar Dasgupta preparing to perform the remote telesurgery operation on 4 March. Photograph: Aaron Chown/PA
“A lot of people actually said to me: ‘You’re not going to do it, are you?’” Buxton said. “I thought, I’m giving something back here.
“I love football – we’ve gone from being in the Championship to the Champions League as far as surgeons are concerned.”
Buxton, originally from Burnham-on-Sea in Somerset, said it was a “no-brainer” to be involved, telling the Press Association he was happy to be the “guinea pig”.
After his cancer diagnosis, Buxton had expected to join the NHS waiting list and travel to England because of the complex nature of the operation.
But then he got the opportunity to have surgery remotely, and jumped at the chance.
“If I hadn’t gone for the telesurgery in Gibraltar, then I would have had to have flown to London, I would have had to go on the NHS waiting list, get the procedure done and I would have probably been in London for three weeks. So I thought: ‘This is a no-brainer,’” Buxton said.
The operation, using the Toumai Robotic System, begins. Photograph: Aaron Chown/PA
“And it is pioneering for Gibraltar, because you don’t need to leave Gibraltar. Normally, any major surgeries, apart from minor stuff, maybe hernias and things like that, you end up having to go to either London or Madrid.”
He added: “It’s been a privilege to be part of medical history.”
Dasgupta said the “milestone” surgery, which took place earlier this year, “went extremely well”.
“We operated on an NHS patient in Gibraltar from the London Clinic 2,400km away using a robot with a 3D HD camera with four arms.
“The robot is completely controlled from a console, which is like a computer console, using high-speed lines with a time delay of, would you believe it, only 0.06 seconds – that 60 milliseconds.”
The console in London was linked to the robot in Gibraltar via fibre optics, with a backup 5G connection. A team on the ground at St Bernard’s stood ready to take over as a precaution in case the connection dropped.
Remote surgery is advancing rapidly around the world, with recent breakthroughs enabling more real-time, long-distance procedures.
Patients in remote areas do not always have access to the best healthcare, Dasgupta said, and remote surgery meant they can be saved “vast expense and inconvenience” in travelling for care.
He added: “I think it is very, very exciting, the humanitarian benefit is going to be significant.”
Dasgupta is due to repeat the remote procedure with another patient on 14 March, this time with 20,000 surgeons watching via livestreaming from the European Association of Urology congress.
