As in any other filed medical field also experiences changes day by day, even in the field of surgery in terms of techniques we accept for a better results for our patients and Oncosurgery or Cancer Surgery field is not an exception.
When we talk about surgery to our patients, the very first concern they raise is the “number of stiches” and of course a life time mark left over the body as well, especially in the areas like neck . A long wound, stretching through out the length of the belly, the trauma caused by the wound and moreover the time taken by a person to come to the normal life, when, become a very large concern the laparoscopic surgery or “Key hole Surgery” stepped in to the filed and become very popular. On the other hand, key hole surgeries are “minimally invasive”, means surgery is done through very small incisions over the belly rather than a very large single wound. Among the multiple small wounds, through one of the holes a camera is introduced in to the abdominal cavity and the surgeon sees all the organs and he operates on the diseased organ. Key hole surgeries or Laparoscopic surgeries have many advantages over the open surgeries in terms for benefit for the patients. Small wounds means less pain and less pain mean a speedy recovery from the surgery and a speedy recovery means attaining a very rapid normal life. Minimally invasive surgery is now common in all surgical Fields
But Cancer surgery is different from other surgical fields. In Cancer surgery “The Oncological Outcome” is the most important principle we follow. It means in Cancer surgery mainly based on the principle of complete removal of Tumour with surrounding tumour carrying tissues. Laparoscopic surgery has been proved to be safe in cancer surgery in terms of “Oncological Outcome” in all cancer surgeries except in a very few organs.
Now minimally invasive surgery have gone one step further and that is called ROBOTIC SURGERY. Whenever we listen to the term Robot, what comes to our mind is a “Machine man” which do things autonomously or by itself. But when it comes to the Robotic minimally invasive surgery, the robot used id totally different. First of we should understand that “In Robotic surgery, The surgery is not performed by a robot, rather it is been done by the surgeon himself/herself”. The surgeon is not directly operating but directs the robotic instruments in a very controlled manner ie a Master-Slave system.
Robotic surgery system has two main components – One. The Console , Two. The Working cart.
The Console is the part where the surgeon sits and works, which is away from the patient. In the console The Surgeon is able to see, the camera vision in a binocular vision , means same as our eyes sees – a three dimensional vision, which is not in normal laparoscopy and is one of the advantages of the robotic surgery system, when compared to the laparoscopy, especially the depth perception.It gives a correct distance of the organ or depth which we are working , which is not with the normal laparoscopic system.
The Surgeon controls the instruments attached to the body of patient with a controlling sticks in the console (It is like by a joystick we control and play the video game).The arms of the robot on which the surgical instruments are attached will replicate the exact movements the surgeon does in the console , but with much more accuracy and precision. Even the current Robotic system available is equipped with measures to rectify fine shaking of the instruments, while doing the surgery.
Yet another advantage is with the Camera of the Robotic system. The camera gives a three dimensional , magnified view of the structures so that even small structures will be seen very clearly. So it helps in viewing very small structures in most difficult areas of the abdomen, like small blood vessels and nerves thus helps in doing a surgery by avoiding injury to these structures and the outcome of the patient will be very good compared to other modality of surgery. Assistant surgeon and the Nurse assisting the surgery will be near the patient and the communication between the surgeon and the assistants will assure a very smooth procedure .The three dimensional vision and the precision of the instruments will provide the patients the best outcome they can have
One of the biggest advantages of the robotic surgery over the laparoscopic surgery is the dexterity of the arms. That means the robotic arms can move in all the ways a human wrist moves. So in other words working with the robotic instruments means a surgeon feels like working with his on hands. That gives a very important advantage for the surgeon , especially in working in very difficult areas like deep in the pelvis or high up in the abdomen, minimizing the chance of complications of organ injury or bleeding. It helps the surgeon to performing manoeuvres like suturing inside the abdomen very easy unlike the laparoscopy. The robotic hand moves in 360 degrees which mimics an open surgery for the surgeon, Which also helps the surgeon to have a less fatigue while doing more complicated surgeries. Since the surgeon has a magnified view which helps in minimizing the organ injury and bleeding, which indirectly reduces the need for blood transfusions and further complications. Altogether Robotic minimally invasive surgery is a very good tool we have which provides our patient s a very safe surgery with a quicker recovery.
As we have discussed with the normal laparoscopic surgery, the “Oncologic outcome” is also very important in case of robotic surgery as well. It has been proved from may studies that robotic surgery in the field of oncology is very safe for the patient as well as in the oncologic outcome perspective, especially in the cancer surgeries of like Uro Oncology , Gynaecology Oncology, Gastroenterology Oncology , Oral Cancers, Thyroid Surgery , Colon and Rectum surgeries etc.
Eventhough there are many advantages to tell about the robotic surgery system in the minimally invasive field, there is one of the most important disadvantage of the Robotic surgery is its cost of the Surgical system, which indirectly affect the cost of the surgery as well. As of today a robotic surgery system is limited to only few centres in India and the cost of surgery is much expensive when compared to open or Laparoscopic surgery all over India.
But when considering the advantages of the Robotic surgery and the advantages it provides to the patients, we can confidentially tell that Robotic Surgery is the Future.