Current status and future
Surgery is an art based on scientific principles that deals with curing the disease by removing or repairing a diseased organ by operating on it. Susrutha is known as the father of surgery. with the evolution and development of anaesthesia (art of putting a person in deep sleep) and knowledge of human anatomy, surgery gained popularity and its now a commonly used method to treat a disease in modern medical science.
Open surgery requires cuts on the surface of the body to reach into deeper parts of the body. Minimally invasive surgery or keyhole surgery is a modern surgical technique in which operations are done by making small cuts on the surface of the body to introduce instruments into deeper parts and avoid big cuts (incisions) on the surface of the body.
Laparoscopic surgery is a type of keyhole surgery that started gaining popularity in the 1990s with advancements in optics (camera and light cables and 3-dimensional vision), refinement in surgical instruments with more flexibility and better energy devices robotic surgery entered slowly in India by the 2010s. Initially used widely in pelvic surgeries like prostate, uterus and colon, now the scope of uses has widened to other surgeries also.
Robotic surgery or robot-assisted surgery is a kind of minimally invasive surgery, where robotic arms enter the human body through small keyholes to perform the surgery. These arms are controlled by a surgeon sitting at a distance on a console.
Uro-Oncology is a sub-speciality of urology that deals with cancers of the genito-urinary system, which includes Kidneys, ureter, urinary bladder, prostate, urethra, penis, testicles and adrenal gland.
Robotic Surgery and Prostate Cancer
The introduction of robotic surgery has revolutionised the treatment of prostate and kidney cancers. prostate cancer cases are rising. Due to rising awareness, routine health checkups and better availability of healthcare facilities at one end and because of increased life span and a large number of ageing population now prostate cancer cases are diagnosed more commonly. also, important to note is that, now more prostate cancers are diagnosed in the early stages, early-stage cases of prostate cancers are curable by surgically removing the prostate gland completely. This surgery is a challenging surgery for most of the urologists to remove the prostate from the deep pelvis and then reconstruct the normal urinary passage requires great skill and experience. urinary incontinence and impotency are common side effects of this surgery. Robotic surgery appears to be the perfect solution for these problems, it makes the access easier, nerve-sparing surgery can be done to preserve the potency, there is minimal scar, minimal pain, minimal blood loss.
Robotic Surgery and Kidney Cancer
kidney cancers and cysts are commonly seen nowadays as incidental findings on abdominal ultrasonography’s done for unrelated causes. most of them are small and do not cause any symptoms. Some of the tumours are seen in patients presenting with the passing of blood in urine. Earlier we used to remove the kidney along with the tumor for many patients. Now many of these tumours can be removed preserving the normal kidney. Robotic surgery has great advantages for this surgery as the cutting of the tumour and repair of the rest of the kidney is much easier by robotic instruments and this is done with minimal scar on the body. Advanced kidney cancer cases with extension into large blood vessels can also be managed effectively by robotic surgery.
Urinary Bladder Cancer patient sometimes require removal of urinary bladder. Robotic surgery is slowly gaining popularity for this procedure, reconstruction of new urinary passage require a lot of skill and this surgery should be done only in high volume centres for better outcome. Artificial bladder created from patients own intestine (Neobladder ) can be done by robotic surgery.
For testicular cancer patients removal of lymph nodes from the abdomen is sometimes needed. this can be done by robotic surgery safely and in a minimally invasive way. For penile cancer patients, groin nodes surgery is sometimes required, this surgery usually has a lot of morbidity and issues with wound healing. VEIL is a kind of minimally invasive robotic technique of this surgery with marked lesser wound healing issues and a great advantage over open surgery.
Like Laparoscopic surgery, Robotic surgery is useful for removing adrenal gland tumours. reconstructive urological surgeries like repair of urinary leaks in utter Vaginal fistulas and Vesicovaginal fistulas and kidney obstruction (pyeloplasty) are done by robotic surgery with great ease and excellent outcome.
Robotic surgery is a game-changer in the surgical approach to urological cancers. with increasing affordability, decreasing cost of the technology and more availability it is going to gain more popularity. Medical science is evolving, technology is evolving and we should be open to learn and adapt to new technology to offer the best possible health care to the common people which is affordable for the majority.