Gastrointestinal-Robot assisted surgery for Gastrointestinal (GI) cancers: Better way or just another way?
Robots to common man may appear fascinating and gadgets from fiction. The fact is that robots are now a reality and have transcended from laboratory to everyday life and are increasingly deployed to perform complex tasks in all walks of life including Medicine.
Medical robots were developed to overcome the limitations of traditional laparoscopic surgery and to extend the indications of minimally invasive surgery where laparoscopy was technically not feasible or very demanding. Currently Robot assisted surgery (RAS) is being performed in increasing numbers across the world including India.
The current times are playing out to be very interesting for robot assisted surgery with evolving indications and many studies comparing its outcomes with traditional surgical approaches. Although robot assisted surgery is being increasingly utilized for management of GI cancer patients, its adoption in the practice is not unchallenged.
Since 2016 when we were initiated into RAS following our visit to Yonsei University at Seoul for advanced robotic colorectal surgery and recently to Johns Hopkins Hospital, USA in 2019 for robotic pancreatic surgery, we have successfully incorporated the technique in clinical practice.
Is robotic surgery safe?
Robotic surgery has been introduced in clinical practice nearly 2 decades ago and since then its safety is well documented. During the period from 2010 to 2015 there is 5-fold increase in the use of robot assisted surgery in USA for cancer patients. Although occasional accidents have been reported due to malfunctioning of the robot but safety of RAS has been widely proven in multitude of studies published.
Outcomes of robotic surgery in terms of immediate postoperative results & oncologic parameters are comparable to traditional open & laparoscopic techniques.
What are the advantages of robotic surgery?
- Robot assisted surgery is more likely to be accomplished in minimally invasive technique in comparison to standard laparoscopic surgery.
- For the patient this translates into less blood loss, less pain, shorter hospital stays and better cosmesis.
This is feasible because of several attributes of the medical robot:
– The robot provides superior quality, magnified 3-dimensional (3D) vision to the surgeon.
– Robotic instruments are designed for wider range of movements and are able to replicate human wrist movements.
– It provides a stable platform for instruments thereby eliminating human fatigue & tremors.
– It also provides for ease in surgical suturing which helps in reconstruction.
– It helps surgeon to operate in closed, narrow spaces in the abdominal cavity such as the pelvis (cancer rectum) where it may be difficult to perform laparoscopic surgery.
What is the current status of robotic surgery for Digestive tract diseases?
Complex surgeries such as esophageal, gastric, pancreatic & colorectal surgery are being routinely performed by robot assisted surgery at centers of excellence.
In summary, robot assisted surgery is safe and its outcomes are comparable to traditional open / laparoscopic techniques with several advantages including shorter hospital stay, decreased conversion to open surgery, less blood loss and organ preservation. We believe, robot assisted surgery is a promising technology and ongoing technological advancements, increased availability & reduction in costs, will lead to expansion of robot assisted surgery for digestive tract surgery in India also.
Dr Nitin Vashistha, MS, FIAGES, FACS
Dr Dinesh Singhal, MS, FACS, DNB (Surg Gastro)
Department of Surgical Gastroenterology,
Max Super Speciality Hospital, Saket, New Delhi, India
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