Cancer Surgeries Using Laparoscopy And Robotic Surgery

Dr.Praveen performs laparoscopic and robotic surgeries for these cancers.

  • Esophagus cancer
  • Stomach cancer
  • Colon cancer
  • Rectal cancer
  • Kidney tumor
  • Endometrial cancer
  • Cervical cancer
  • Mediastinal tumors

Laparoscopic and robotic surgery have revolutionized the surgical field in recent times. Despite the initial hindrances both these approaches have been embraced by cancer surgeons all around the globe. There have been numerous high quality scientific researches that have proven that laparoscopy and robotic surgery is safe in cancer and provide outcomes that are on par with, if not better than, open surgery. Both these treatment modalities have distinct advantages in terms of lesser pain, early recovery and shorter hospital stays which provide a unique advantage in cancer treatment.

How are these surgeries performed? How are they different from open surgeries?

Both laparoscopic and robotic cancer surgeries are collectively termed as minimal access surgery which means using much smaller incisions compared to open surgeries performed for cancer. To achieve an oncologically safe removal of cancer affected organs along with its draining lymph nodes an open cancer surgery requires relatively large surgical incisions compared to open surgeries done for non cancer related diseases. Such large incisions incite a reaction from the body’s protective mechanisms which leads to greater degrees of inflammation in the tissues. Along with it, a greater amount of pain. Both combined together affect patients breathing, mobility, requirement of pain medications, gut mobility etc. Contrary to this , both laparoscopic and robotic cancer surgery use 4-6 small incisions ( varying from 5mm to 12mm each). These incisions are strategically placed in different quadrants of the abdomen or chest wall so that the affected organ can be removed adhering to oncological principles.

Fig 01. Traditional open surgery
Fig 01. Traditional open surgery
Fig 03. Small scars of laparoscopic surgery performed for removal of rectal cancer and stomach cancer together
Fig 03. Small scars of laparoscopic surgery performed for removal of rectal cancer and stomach cancer together
Fig 04. Small scars Of VATS surgery for esophgeal cancer
Fig 04. Small scars Of VATS surgery for esophgeal cancer
Fig 02. Position of robotic port for esophageal cancer surgery
Fig 02. Position of robotic port for esophageal cancer surgery

If such small incisions are used, how is the cancer affected organ taken out?

To facilitate the extraction of the affected organ a small incision measuring 6-8cm is used. Most of these incisions are away from the midline of the body and division of muscles is usually avoided. Hence these specimen extraction incisions rarely add to the pain significantly.

In laparoscopic and robotic gynecological/colorectal surgeries the specimen(resected organ) can be extracted either through the vaginal opening or through the anal opening. This is called Natural Orifice Specimen Extraction ( NOSE). This method avoids additional incision on the abdomen.

Why are robotic and laparoscopic surgeries necessary in cancer treatment?

It has been proven time and again that minimal access surgery leads to lesser blood loss, less pain, early recovery, earlier return of bowel functions, better post operative rehabilitation. All these advantages translate into shorter hospital stay and reduced treatment costs.

Almost all cancer patients require multimodality treatment.i.e. combination of surgery, radiation and chemotherapy. And each one of this has to be incorporated into treatment planning in a timely manner to gain the maximum benefit out of it. In this context an early recovery provided by minimal access surgery is a great benefit to the patients.

Can all cancer surgeries be performed by laparoscopic and robotic surgery?

Regardless of the method used ( open or laparoscopic or robotic ) a cancer surgery has to respect the oncological principles of surgery.

Oncological principle means-

  1. Complete removal of the tumor with a margin of healthy tissue so that not just the tumour that is visible on the scans and to naked eye but also the possible microscopic cancer deposit and cells that may be present in the surrounding normal looking tissue are removed. How much of a healthy tissue margin is to be removed varies depending on the organ that is affected by the cancer.
  2. The lymph nodes that drain the cancer affected organ also have to be removed during the surgery.
  3. Spillage of cancer tissue or cells into other areas is to be avoided at all costs.
  4. Technically any method of surgery that respects these principles and can achieve a successful surgery, should be acceptable.

However, only in those organs and cancer stages where laparoscopic and robotic cancer surgeries have been studied and proven to be safe, is using these modalities recommended by national and international organizations of surgical oncology.

As a general rule only early stage cancers and cancers that are still within the confines of affected organs with limited spread to the surrounding nodes are ideal candidates for laparoscopic and robotic surgery.

The following cancers can be dealt with using laparoscopic and robotic surgery

  • Cancer of esophagus
  • Cancer of stomach
  • Cancer of small intestine
  • Cancer of colon
  • Cancer of rectum
  • Cancer of uterus ( endometrium)
  • Cancer of the cervix
  • Cancer of kidney
  • Mediastinal tumours
  • Thymic Tumours
  • Lung cancer
  • Prostate cancer

Performing a surgery is a combination of knowledge, skills, training and experience. Even complex minimal access surgeries like pancreatic cancer surgery, liver cancer surgery, partial nephrectomy can be performed by experienced and skilled surgeons with excellent results. More than one cancer affected organs also can be resected using laparoscopy or robotic surgery. The feasibility of minimal access surgery has to be balanced with oncological safety to achieve optimal results.

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