Robotic esophagectomy is a procedure performed by surgically extracting the diseased part of the oesophagus (the foot-long conduit connecting the back of the throat to the stomach) for the treatment of oesophageal cancer. Robot-assisted surgery is increasingly being used to treat this disease, as it enables the intra-abdominal oesophagus and stomach to be completely mobilised without the need for a broad abdominal incision, resulting in less pain and scarring following surgery, and quicker recovery.
Robotic systems enable surgeons to resolve the limitations of laparoscopic approaches to esophagectomy and thoracoscopic approaches. It facilitates three-dimensional visualisation, enhanced magnification and a wider range of motion of the instrument, potentially minimising intraoperative complications during mediastinum oesophagal dissection. Robotic technology is being used for esophagectomy at the Apollo Hospitals. During the thoracic dissection of the oesophagus, gastric mobilisation and intrathoracic anastomosis, robotic procedures may be carried out. It can also be achieved in conjunction with laparoscopic, laparoscopic or thoracoscopic hand-assisted approaches.
In the right and left sub-costal positions, three 8 mm ports are positioned for the robotic abdominal approach. The camera is positioned in the supraumbilical position and the right paramedian position is placed with a 10 mm assistant port. With 5 mm ports and cameras, the laparoscopic method uses identical positions. The left subcostal and left paramedian positions are placed with two additional 5-mm trocars. On both methods, the feeding jejunostomy is brought out through a port site on the left, removing an extra incision. Three to four small keyhole incisions, each approximately half an inch long, are made in the upper belly, chest, or lower neck during the operation.
On a magnified, 3D monitor, the surgeon uses a laparoscope to view the surgical site while manipulating tiny computer-aided robotic instruments to perform the operation. The need for thoracotomy, laparotomy, or both are eliminated by robotic surgery, which decreases postoperative pain, wound infections, ventilator dependency, cardiopulmonary complications, ICU and hospital stays, and mortality rates.
Robotic Gyane Oncology Surgery
Robotic surgery for the treatment of gynaecological cancers allows cancer-bearing organs and tissues to be removed by minimally invasive surgery using advanced surgeon-manipulated robotic surgical instrumentation. Early on, gynaecological oncologists recognised that less surgical morbidity was associated with minimally invasive surgery and that it shortened postoperative recovery. Robotic surgery is now an accessible alternative to traditional laparotomy.
Robotic surgery varies significantly in important ways from laparoscopic surgery. Conventional laparoscopy uses a two-dimensional camera with images projected inside the operating room to monitors located near the surgeon. Surgery is conducted by incisions of 5 to 12 millimetre’s through which a camera and rigid instruments are positioned through abdominal ports and directly operated at the surgical bedside by the surgeon. Limitations commonly mentioned for traditional laparoscopy.
It remains an open question for many gynecologic oncologists whether robotic-assisted minimally invasive surgery in all gynecologic cancer patients can be substituted for traditional laparotomy. Robotic surgery appears to provide adequate surgery from the available evidence in patients with cervical cancer to determine pathological tumour size, tumour grade, deep invasion of the cervix organ, lymphovascular invasion, cancerous lymph node status, and cancer-free resection margins without unnecessary risk of intraoperative resection.
In the surgical treatment of endometrial cancer, robotic surgery has become the current gold standard. The benefits of robotic-assisted surgery in women with endometrial cancer were soon recognised by gynecologic oncologists. Simple surgical technique, adequacy of surgical specimens for cancer staging, and reduction of patient hospital stay and time to recovery were praised in initial studies. A basic benefit of the robotic platform was surgical faith inadequate lymphadenectomy (i.e. > 4 lymphadenectomies).
Epithelial ovarian cancer treatment is based on optimum cytoreductive surgery, with the residual disease of less than 1 cm. Minimally invasive procedures have been attempted since the 1990s to maximise cytoreduction of ovarian cancers. An open question is whether robotic-assisted surgery increases the ability to surgically minimise ovarian cancer. Although improved ergonomics may assist in radical surgery of this kind, other limitations inherent in the robotic platform remain a major drawback, namely the inability to operate simultaneously in the pelvis and abdomen.
It is an option for early ovarian cancer. In general, unless further research indicates otherwise, the use of robotic surgery in the treatment of ovarian cancer is not recommended. Our gynaecological oncologists may conduct a major procedure in a minimally invasive fashion via the robotic platform. To accommodate the miniaturised robotic instruments and the tiny camera inserted into the patient’s abdomen, only a few small incisions are required, rather than a large incision. These are also critical surgical procedures, but they are carried out by minor incisions, resulting in far less blood loss, discomfort and scarring and less chance of infection than traditional open surgery.
Dr. T P S Bhandari
M.B.B.S M.S (General Surgery) Diplomate National Board (General Surgery), FISO (Surgical Oncology ) MCh (Surgical Oncology) Breast Oncoplastic Surgery (Royal College Surgeons LONDON) Fellowship in Breast Surgery (Royal College Surgeons LONDON) Robotic Fellowship – Minimal Invasive Robotic Institute
Dr. Sanjai Addla