The last two decades have seen a major change in surgical oncology. In
the 80s and 90s, the primary focus was to get the tumor out with good
margins and get the patient home alive.
While chemotherapy and radiation were available the options were limited
and were predominantly used in an adjuvant or palliative setting.
Very few extremely skilled or bold surgeons explored minimal access
surgery and were often ridiculed. The last two decades have seen an
avalanche of new chemotherapy drugs in the market with many molecular
and immunotherapy agents. These have improved outcomes of many cancers
either by downsizing tumors before surgery (neoadjuvant therapy) or by
taking care of potential cancer cells after surgery (adjuvant therapy).
This has enabled surgeons to operate on more cancers than before while
preserving better functionality.
The technology of medical devices has grown by leaps and bounds thus
enabling better instruments, better cameras, and software to help
surgeons.
More and more surgeons started opting for minimal access surgery for
their patients in order to enable them to recover faster, have lesser
pain, early return to home, and work with the same oncological outcomes.
The biggest innovation in the minimal access surgery space has been the
surgical robot.
The arms of the robot are docked on the patient and the instruments are
attached to the robotic arms. Every movement of the instruments is
controlled by the surgeon at the console. One of the common
misconceptions is that it is the robot performing the surgery which is
not true. It is ALWAYS THE SURGEON who performs the surgery... the robot
is only an advanced instrument that enables safer surgery.
So what are the advantages of the robot over laparoscopy?
In some areas like the pelvis which is narrow, the robot clearly scores
over laparoscopy.
The robotic arms have far greater dexterity than laparoscopic
instruments. The magnification is much more, the camera is 3D, and the
wrist of the robot provides seven degrees of motion compared to only two
dimensions in laparoscopy.
The robot also has an inbuilt intraoperative ultrasound to locate small
tumors and an ICG system which enables the surgeon to check the
vascularity of the bowel before joining it, rule out bile leaks, and
identify bile ducts, etc. thus enhancing surgical safety.
Newer software has superimposition of scan images making it easier for
the surgeons to operate.
However, it is important to realize that patients should be carefully
selected for robotic surgery and large bulky tumors will still need open
surgery.
With more and more advances in tech, the robot will be more accessible to
all and at reasonable costs and more surgeons will be able to use it
effectively.