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Case Study

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Robotic Oncological Surgery: Technology That's Here to Stay!!
Over the past decades, surgery has also transitioned from the open approach, where the surgeon can directly touch and feel the tissue, to an intermediate state - laparoscopic surgery - where the surgeon moves the tip of the instruments, but the visual feedback is provided through the electronic image of the organs on the monitor, to Robotic Surgery (RS), where the image (information) at the surgeon’s console represents the real surgical workspace. During RS, the surgeon is immersed and in control of a computer generated environment (so called ‘virtual reality’) sending electronic signals from the joysticks of the console to the tip of the instruments, which mimic the surgeon’s hand movements.

The use of robotics in Medicine dates back 75 years, but only during the past 10 years has its potential been recognized around the world. In 1985, a robot, the PUMA 560 was used to place a needle for a brain biopsy under CT scan guidance. In 1988, the PROBOT was used to perform prostatic surgery (Institute of Urology,University College, London). The ROBODOC from Integrated Surgical Systems was introduced in 1992 and is a robot to ream out precise fittings in the femur for hip replacement surgery. Furthermore, in the orthopaedic field the ACROBOT has been used for knee surgery developed at University College Hospital. Further development of master-slave robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Robot and Computer Motion with the AESOP and ZEUS robotic surgical systems.

Since the first reported robot assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium.

Oncological Surgery involves large open incisions (Laparotomy, Thoracostomy and Lumbotomy). There is an associated blood loss; longer recovery period and painful postoperative period that requires more analgesia. Laparoscopic surgery avoids most of the side effects of open surgery while maintaining oncological integrity. Furthermore, Robotic Surgery maintains the advantages of Laparoscopic Surgery but reduces some of its limitations such as learning curve.

Robotic Oncological Surgery is a Targeted Therapy, focused on tumour treatment avoiding the general side-effects of open surgery. The recent development of robotics in surgery has demonstrated that it is a feasible and reliable therapeutic approach for cancers.

Robotic Uro-Oncology is an expanding field, particularly as an option for the treatment of localized prostate cancer. The daVinci robot with three-dimensional visualisation is helpful for preserving bladder neck and neurovascular bundles and at the same time the endowrist allows simplification when performing of the urethral vesicle anastomosis. In most of the studies the robotic procedure appeared to be safer, less bloody and required shorter hospitalization and catheterization. The oncological and functional results were favourable in patients undergoing robotic prostatectomy. The robotic surgery modality is also being applied to renal cancer, bladder cancer and retroperitoneal lymph node dissection in testicular cancer.

The feasibility of performing low anterior resections and abdomino-perineal surgery has attracted the attention of colorectal surgeons. Similar to robotic prostatectomy for urologists, limited visibility during these procedures when performed open is a major obstacle and RS can allow for improved visualization and excellent rectal dissection.

Regarding the robotic abdominal surgery for cancer, an extraction of esophageal tumor, a distal gastrectomy for gastric cancer, an ileocecal resection for cecal cancer, a left hemicolectomy for descending colon cancer, a sigmoidectomy for sigmoid colon cancer, a thymectomy for thymoma and an extraction for retromediastinal tumor have all been performed successfully. As a result, almost all types of tumors or cancers may therefore be indicated for robotic surgery

Various studies of Robotic radical hysterectomy for uterine and cervical cancer has  highlighted the advantage of using robotic assistance within a confined space (extended hysterectomy with pelvic lymph-node dissection).

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