Robotic surgery

Robotic surgery is the current state-of-art system of physically manipulating the internal organs in a precise manner in order to remove the lethal diseases like cancers, repair the dysfunctional organs or perform any other procedure with minimal disturbance to adjacent tissues .This translates into minimal blood loss, little post operative pain, early recovery and a shorter stay in the hospital. In order to understand how it occurs, one should imagine following

  1. If the size of human wrist were to be reduced to less than a centimetre and our eyes were placed within a space of little more than a size of pen
  2. These were inserted into the human body through small holes, sufficient enough to allow them to reach the target organ within the human body
  3. There would hardly be any disturbance to other organs of the body while a precise procedure could be carried out within the human body.

The urinary tract consists of two kidneys, their respective drainage pipes called ureters which drain the urine into a reservoir called urinary bladder. Here onwards, urine passes out of body through urethra, which is a short tube, almost four centimetres in females. In males, urethra is a much longer tube and passes through prostate gland before finally exiting the body. Thus, the urinary tract in male consists of additional structures like prostate, penis and testicles. Cancer can affect any of the structures of urinary tract in either sex and could be lethal. Robotic surgery has made it possible to treat these cancers in a precise manner saving several lives and reducing discomfort.

A) Cancer of Prostate

Cancer of prostate is the commonest cancer in males. Once diagnosed, this can be categorized into

  1. Organ confined disease
  2. Locally advanced cancer
  3. Wide spread disease (metastatic cancer)

Early diagnosis of this disease can be facilitated by a simple blood test called PSA. This should be done in men above 50 years of age or in younger men if any of their blood relatives have had a diagnosis of prostatic cancer. If the disease is confined to prostate gland, then it is possible to remove the gland and aim to cure the cancer. Removal of prostate gland is technically challenging as it is located at the bottom of the body, in the depths of pelvis. Even more difficult is the process to reconstruct the junction between urethra and the bladder. Before the advent of robotic surgery, it was a very difficult operation necessitating blood transfusions and long hospitalization. Robotic surgery has made it a relatively comfortable operation, both for the patient as well for the operating surgeon. Technically called 'robotic assisted radical prostatectomy’ this operation allows shorter anaesthesia time, quicker recovery and early discharge from the hospital; usually within 2-3 days of surgery. The results in terms of control of urination and preservation of male sexual function are much better than the open operation. The outcome in terms of control of cancer is also comparable with open surgery.

B) Cancer of the Kidney (Renal cell carcinoma)

Cancer of the kidney is another disease where robotic surgery has made a paradigm shift. With advent of ultrasound and its widespread use as a screening modality, a number of otherwise asymptomatic mass lesions are being identified in kidneys, which on further investigation turnout to be cancerous in nature. In a way it is fortunate to pick up early cases of kidney cancers as these can be precisely removed from the body using robotic surgery. Not only does this aim to cure the cancer, it also preserves the kidney. This procedure, termed as 'robotic partial nephrectomy' involves cutting away the cancerous portion of the kidney and sewing the cut edges to retain the rest of it. This involves minimal blood loss and quick recovery of the patient. Robotic partial nephrectomy is a boon for patients with critical kidney function or patients who develop cancer in their only 'single kidney '.

Thus, robotic surgery not only saves life of a patient with cancer of kidney, it also helps in retaining the kidney if the cancer is diagnosed at an early stage.

C) Cancer of the Urinary Bladder

Cancer of the urinary bladder when invades into its deeper layers, then the whole bladder needs to be removed in order to save the patient. Robotic surgery is very useful for removal of bladder and lymph nodes situated in the pelvis. Having removed the bladder, reconstruction of ‘neo-bladder' or a new bladder from a segment of intestine and connecting it to the urethra is facilitated to a great extent by the robotic surgery.

D) Cancer of Testis

Cancer of the testis in males is notorious for spreading to the lymph nodes in the depth of abdomen, close to the large blood vessels like aorta and inferior vena cava. In certain situations, these deep seated lymph nodes need to be removed surgically. Robotic surgery makes this reasonably simpler than open surgery by reducing the period of post operative recovery of the patient

It can therefore be said that advent of robotic surgery is a huge leap forward in the way surgical treatment of cancers of urinary tract is being done in 21st century. Not only does it allow surgical procedures to be carried out in a precise manner, it translates the entire experience of the patient into less traumatic one with minimal pain, lesser hospital stay and quicker recovery.

For robotic surgery to be useful, it is important to diagnose cancer at early stages. Various health agencies are running programs for early diagnosis of cancer, which eventually lead to the overall goal of reducing the suffering and prolonging life in patients with this dreadful disease.