By: Dr. Surender Kumar Dabas
It is well known that minimizing the impact of oncological treatment is the way not only to improve cancer patients’ quality of life, but also to increase compliance to treatment and ultimately the chances of a cure. Maintaining oncological standards, improving perioperative outcomes and functional results, and minimizing complications, are the principles that inspired the minimally invasive approach in oncological surgery. The laparoscopic technique has been a revolution in particular for gynecological surgery, as well as abdominal and urological surgery. Less scarring, less pain, visual magnification, and the pneumoperitoneum tamponade effect reducing the risk of bleeding are the strengths of laparoscopic surgery. On the other hand, 2D vision, counterintuitive movements and instruments with few degrees of freedom rendered laparoscopy a technically challenging approach. The introduction of Robotics at the end of the last millennium has led to a revolution, fixing all the shortcomings of laparoscopy. There are numerous advantages of Robotic surgery which include 3D HD vision, 7 degrees of freedom, more precision and control, meticulous dissection, better ergonomics, improved dexterity, endo-wrist movements, 10X magnification and greater instrument stability. Robotic-assisted surgery is expanding the capabilities of surgery and is changing the face of medical care.
Robotic Surgery is very safe, infact much safer than open surgery in skilled hands. The machine is not a true robot (it does not operate or move by itself), but is a “master slave” unit. This means the surgeon is in complete control throughout the procedure, and controls the instruments at all times. Robot allows more-precise tremor-free movements in tiny spaces. Tumours can be dissected free from surrounding tissues safely.
A great constraint to the wider and far reaching application of Robotic Surgery is the cost factor, robotic surgery being perceived as way too expensive. Overall robotic surgery is not expensive as compared to open surgery. Definitely ,the initial cost involved is higher because of the costly equipment involved but the long term benefits offered by robotic surgery even out the initial cost. Patients have shorter hospital stay , rapid recovery , early return to the work and less work hours lost. In some cases the need for chemoradiotherapy may be reduced or even eliminated.
In abdominal surgery, robotic surgery can overcome the intrinsic limitations of laparoscopic instruments and can be useful for various cancer surgeries of the Pancreas, Stomach, Gallbladder, Liver and Colon. Robotic surgery finds special application in the treatment of Rectal cancers in terms of better functional outcomes and preserving the normal continence of the patients.
In thoracic surgeries for Lung cancer, Esophageal cancer and other mediastinal tumours robotic surgery avoids the large thoracic incision and provides earlier return to normal routine with better perioperative outcomes and less complications.
Regarding the commonest robotic operation, radical prostatectomy, there is increasing evidence reporting functional advantages for robotic surgery compared to open while as robotic surgery also offers advantage in other urology surgeries like radical nephrectomy, partial nephrectomy, and radical cystectomy. At the same time, Robot provides better vision and outcomes in pelvic surgeries like those for the Gynecologic Cancers of Uterus, Ovary and Cervix.
Beyond the abdominal approach, TORS (Trans Oral Robotic Surgery) represents one of the most interesting experiences of extra abdominal robotic application. Nowadays TORS may be applied for benign and malignant lesions of the upper aero-digestive tract like throat and voice box cancers attaining good functional results in terms of return to normal speech, avoiding disfiguring mandibulotomy and long incisions on the neck and face. Similarly Robotic Thyroid Surgery offers the same oncology outcomes with no neck scar. Faster return to normal function allows patients to begin adjuvant therapy, if warranted, much sooner than in patients who undergo open surgery, affording potential advantages and benefits over current treatment modalities of head and neck tumors.
The global overview of existing robotic experiences demonstrates multiple opportunities for surgical indications in the oncological setting. The miniaturization of the instruments and further technological advancements provide a glimpse of an even less invasive surgical approach for the near future. With the advent of robotic surgery a new surgical era has dawned in the field of Oncology , where with manageable costs , we can offer better functional surgical outcomes to the cancer patients without compromising on the conventional principles of oncology.
The writer is Vice Chairman – Oncology & Chief – Robotic Surgery, BLK-Max Super Speciality Hospital, Delhi
