Minimal Access Surgery in Cancer
What is minimal access surgery?
Traditionally, surgery is performed using a large open incision. Minimal invasive surgery includes laparoscopic and robotic surgery which use small incisions ( 5mm to 12mm ) to access the abdomen and thoracic cavity to perform surgeries.
What are the advantages of
minimal invasive surgery?
| Minimal Invasive surgery | Open Surgery |
|---|---|
| Small Incisions | Large Incisions |
| Minimal blood loss | More blood loss |
| Minimal post-operative pain | Significant post-operative pain |
| No difficulty in walking, coughing, exercising | Difficulty in walking, coughing , exercising |
| Early recovery of bowel function | Delayed bowel recovery |
| Shorter hospital stay | Longer hospital stay |
What is Laparoscopic
surgery?
In laparoscopic surgery, the surgeon makes a small incision close to the belly button and inserts a laparoscopic trocar into the abdomen in a controlled manner. This trocar is a short tube through which instruments and camera can be inserted into the abdomen.
Once the trocar is inserted, a laparoscope (a thin long metallic tube with a camera) is inserted through it into the abdomen to confirm safe entry. Then abdomen is inflated with air or CO2 ( this is called “ pneumoperitoneum “ ).
This is necessary to create working space inside. After this step, few more trocars are inserted for instruments to perform surgery. Assistant holds the camera while the surgeon operates with two instruments. Sometimes a second assistant is also needed.
The number and placement of other trocars ( also called ports ) depends on the organ that is being operated upon.
What is Robotic surgery?
- The first few steps of robotic surgery are similar to laparoscopy. In robotic surgery unique robotic trocars are available and these are utilized instead of laparoscopic trocars.
- Instead of laparoscope, a robotic endoscope is used to visualise the abdomen. This is much heavier and longer than a laparoscope. Air or CO2 is instilled in a similar fashion. Once all the ports are inserted, the robot is brought in and arms are connected to the ports.
- The robot is oriented to perform surgery on a specific organ. The process of connecting the robot to specific robotic ports is called “ docking “
- The surgeon takes control of the robot via the surgeon console, which is away from the operating table. The surgeon uses the controls on the surgeon console to perform surgery. There is usually an assistant beside the patient to give feedback, change instruments and assist him in surgery.
Can laparoscopy and robotic
surgery be used in cancer?
Yes. There is enough scientific evidence to support the use of these methods in cancer surgery.
A valid fear in applying these techniques is about the oncological safety. Oncological safety is the ability to perform a cancer surgery that adheres to the prevailing surgical standards endorsed by experts and international guidelines. With proper training and experience this oncological safety can be achieved with laparoscopic and robotic surgeries as well. This has been proved with time and again by robust scientific research.
What cancers can be operated
upon using these techniques?
- Esophageal cancers
- Early stomach cancers
- Distal pancreatic cancers
- Colon cancers
- Rectal Cancers
- Kidney tumors
- Cancers of the uterus
- Prostate Cancer
