Robotics has transformed the field of surgery and offers several benefits. It allows surgeons to operate with ease even in relatively less accessible areas of the body by providing maximum dexterity and a magnified view of the surgical field. Many surgical specialities have incorporated robotic surgery into their operative management for a variety of cancers, especially urologic (kidney, bladder, prostate), and gastrointestinal cancer (stomach, pancreas, colorectal). First, small incisions are made on the patient’s abdomen for placing ports for the camera and the robotic arms. Then, the robot is docked, and instruments are carefully guided into the surgical field.

The operating surgeon comfortably sits on the master console some distance away from the operating table. The surgeon has a real-time magnified HD-3D view of the operative field and his hand movements on the console are precisely replicated by the robotic instruments in the surgical field. The instruments can be manoeuvred like the human wrist providing 7 degrees of freedom (EndoWrist Instruments) without any tremors. It is beneficial for surgeons as it re-establishes good hand-eye coordination and provides better ergonomics as the fulcrum effect is eliminated in the robotic system, making instrument operation more natural. This dexterity is unattainable by laparoscopic and open surgery.

During some major surgeries, surgeons usually witness major arteries and other vital organs close to the region of cancer. Complications like haemorrhage and injury to vital surrounding organs may arise. With the precision-centric approach of robotics, radical procedures can be performed with the preservation of nerves, arteries and other critical structures without compromising the cancer treatment outcomes.

Advantages of Robotic Surgery

• Minimally invasive
• Considerably less post-operative pain
• Reduction of Surgical Site Infections (SSI)
• Reduction of blood loss
• Shorter Hospital Stay
• Early recovery and return to daily routine
• Magnified High-Definition 3D image
• Precise movements with EndoWrist Instruments
• Potential Reduction of Positive Surgical Margins
• Enhanced Ergonomics leading to less fatigue
• Shorter learning curve compared to conventional Laparoscopic surgery
• Improved Training

Preparation of patients for robotic surgery

People are usually less familiar with robotic surgery, and it is necessary to discuss the procedure, its benefits, potential risks and complications in detail. Robotic surgery is costlier than a conventional laparoscopic and open surgery which must be notified to the patient prior. This added cost is balanced out by reduced complications and shorter hospital stays. This discussion builds up the necessary confidence in the patients to undertake the procedure. Enhanced Recovery After Surgery (ERAS) protocol is followed to optimise patients prior to surgery. Future of Robotic Technology in Cancer Treatment

In terms of practicality, oncological safety, and learning curve, robotic procedures in cancer have demonstrated encouraging early outcomes. Today, computer systems are far superior at processing multidimensional spatial frames of reference than the human mind. The ability to supply robotic surgical systems with real force reflection and haptic feedback is one of the important grails of robotic surgery.

The two major scopes of robotics in cancer care are the following:

• Augmented Reality (AR) – AR provides an advanced user interface that enhances a surgeon’s perception translating into improved dexterity and precision. This can be achieved through various means, like a Projector based AR or a Head-Mounted Display (HMD). AR integrated robotic surgery is still evolving, and one can expect its clinical use in the near future.
• Newer robotic systems like Senhance, Versius, Avatara, and Hintori have developed in recent years with various design modifications like miniaturisation of instruments, providing haptic feedback and eye-tracking control of the camera. This competition will usher in faster innovations and potentially reduce the cost of surgery.

The future of robotic surgery is exciting and we expect new technologies will enable surgeons to provide the best patient care in a cost-effective manner.

Dr Raghunath SK, Director and HOD – Urologic Oncology and Robotic Surgery, HCG Cancer Hospital, Bengaluru

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