Belfast’s first gynae robot takes on complex endometriosis surgery
Colleen Crothers spent years waiting in pain before finally reaching surgery for chronic endometriosis. By the time treatment arrived, the disease had already shaped major parts of her life: work, family plans, and her mental health. Her case now sits at the center of a wider shift in Northern Ireland, where Belfast City Hospital has introduced the da Vinci gynae robot in an effort to move complex pelvic surgery through the system more efficiently.
The device is the first of its kind on the island of Ireland and one of only a few in the UK. It is operated by surgeons, not autonomously, but its articulated arms are designed to work in the tight anatomy of the pelvis with greater steadiness and precision than standard laparoscopic instruments. In endometriosis surgery, where tissue can be fixed to the bowel, womb, ovaries, and surrounding structures, that extra control can matter in very practical terms: smaller incisions, cleaner dissection planes, and less collateral trauma to nearby organs.
One sentence captures the urgency of the problem. Women have been waiting about seven years on average for complex gynae surgery in Northern Ireland.
A disease that can close in on the bowel, womb, and daily life
Endometriosis is not simply painful periods. Tissue similar to the lining of the womb grows outside it, commonly around the ovaries, fallopian tubes, and pelvis, where it responds to hormones and bleeds, scars, and inflames nearby structures. Over time, that process can create adhesions and distorted anatomy. In Colleen’s case, surgery later included a hysterectomy and a full bowel shave to remove tissue that had attached her womb to her bowel, a reminder of how invasive the disease can become when care is delayed.
Her symptoms began at 14, with chronic period pain that continued for decades. Yet referral to gynaecology came only 22 years later, after a scan finally confirmed both adenomyosis and endometriosis. That delay is not just administrative; it is biological. The longer endometriosis remains untreated, the more likely it is to cause scarring, chronic pain sensitization, and fertility damage that may no longer be reversible when surgery eventually arrives.
Colleen described the pain as stabbing, and there was a point when she ended up in the emergency department screaming with it. She is now pain free after surgery, but the path to relief left a permanent cost: early menopause and the knowledge that she cannot have children. For many patients with severe disease, the goal of treatment shifts from cure to containment, and timing determines whether fertility-sparing surgery is still possible.
A robot meant to keep complex cases from slipping down the list
Belfast City Hospital took delivery of the robot in May at a cost of £2.4m, funded through charitable donations for gynaecological services within the trust. Since then, it has performed 130 surgeries, including 105 procedures in women with complex endometriosis, and four consultants have been trained to use it. The numbers matter because they show more than novelty; they show capacity being built around a cohort of patients whose operations are typically long, technically demanding, and easy to postpone when other pressures hit the operating theatre.
The practical advantage is simple. Complex gynaecology cases can be treated as a priority rather than being pushed aside when other surgical demands arise, including cancer cases. Robotic surgery does not remove the need for expert hands, anesthetic planning, or multidisciplinary judgment. It does, however, give surgeons another way to manage difficult dissections with improved visualization and fine instrument control in confined spaces.
Dr Hans Nagar, a consultant gynaecological surgeon and oncologist, said women with complex endometriosis had previously been ill-served in Northern Ireland. He described the robot as a tool that now allows different specialists to work together on cases that once needed to be referred or delayed. He also said the system may help retain younger staff, who may otherwise leave for training and jobs elsewhere in Canada, Australia, the UK, or the Republic of Ireland.
That workforce angle is not peripheral. Surgical technology can attract, train, and keep clinicians, and in a service under strain that can be as important as the machine itself.
Faster recovery, less scarring, and a narrower surgical footprint
The bedside argument for robotic surgery is not glamorous. It is about tissue handling. Lauren Best, a theatre nurse, said women need to get back on their feet as quickly as possible, and she linked that recovery to less scarring and quicker healing. In pelvic surgery, reduced trauma often translates into less postoperative pain, fewer wound complications, and an earlier return to mobility and work, all of which matter to patients recovering from long-standing disease.
That said, the robot is not a cure for endometriosis waiting lists on its own. It is one piece of a larger service redesign that includes new regional centres and more funding for local care. On Monday, the health minister is expected to announce £1.95m for endometriosis services across Northern Ireland, including £700,000 for two regional centres at Belfast City Hospital and Altnagelvin Area Hospital, plus £250,000 for each health trust to support women with less complex symptoms. The structure suggests a two-tier strategy: specialized centres for the hardest cases, and broader support for women whose disease can be managed without referral to a tertiary surgical team.
That model fits the way endometriosis behaves clinically. Mild disease may be controlled in community or general hospital settings, but complex disease often demands high-volume expertise, careful imaging, and surgeons comfortable operating around bowel, bladder, and pelvic nerves.
Relief arrived late for one patient, and that is the point
Four months after surgery, Colleen has returned to work, walks her dog again, and says she finally has her buzz back. Her stomach feels lighter, and the pain that once dominated every day is now largely gone. Her experience is encouraging, but also sobering: the benefit of surgery is unmistakable, while the delay that preceded it cannot be undone.
For patients behind her, the question is whether new funding, specialist centres, and robotic capacity can shorten the gap between symptoms and treatment before fertility is lost or pain becomes entrenched. Belfast’s new robot cannot reverse years of missed care, but it may prevent the next woman from reaching the same endpoint after waiting too long.