Robotic Surgery – Cancer, Hernia, Gallbladder Surgery

What is robot-assisted surgery?

Robot-assisted surgery is a type of minimally-invasive surgery completed through small incisions. The da Vinci surgical system uses high-definition, three-dimensional cameras that magnifies image 20 times coupled with specialized surgical tools that enable surgeons to operate with more precision and better control.

The robotic instruments have mechanical wrists that bend and rotate to mimic the movements of the human wrist thus allowing surgeons to make precise movements. Robotic software also negates the effect of surgeons’ hand tremors.

It is an effective minimally invasive alternative to both open surgery and laparoscopy. Surgeons undergo vigorous training with this system before being allowed to use it for surgery on patients. Moreover, there are many inbuilt safety checks in the system that decreases the chances of error. Patients can be rest assured knowing they’ll receive superior surgical care for the best possible outcome.

How robot-assisted surgery works ?

During robotic surgery, your surgeon inserts a tiny camera through a small incision in the surgical area. The camera sends a high-definition, 20 times magnified, 3D image of the surgical site to an external monitor in real-time.

Using computer-assisted technology that guides specialized surgical instruments, your surgeon directs the robot with better control, precision, and range of motion than is possible with traditional surgery. A support team assists the surgeon with other surgical tasks.  Thus the use of a robotic system makes difficult steps easier for the surgeon by providing a range of motion and more maneuverability in handling tissue and suturing.

Will the surgeon be with me in the operating room?

Many patients wonder who is operating on them: the robot or the surgeon.

Robot-assisted surgery is a system that enables surgeons to operate with precise, delicate motions by controlling the machine. The robot never makes decisions or performs incisions on its own — it only responds to your surgeon’s hand and finger movements.

Your surgeon is located at a console in the operating room near you and the experienced support staff, directing the procedure the entire time. The robot allows for greater precision than the human hand has on its own, and your surgeon is in charge the whole time.

Conditions that can be treated with robot-assisted surgery

The majority of gastrointestinal issues can be  addressed using robotic-assisted minimally invasive surgery, including:

  • Appendicitis
  • Hernias
  • Gallbladder disease and its cancer surgery
  • Gastroesophageal reflux disease (GERD)
  • Liver surgery
  • Surgery of the pancreas including surgery for cancer of the pancreas
  • Surgery for the colon and rectum including its cancers
  • Surgery for the esophagus, stomach, and intestine
  • Gastrointestinal and liver cancer surgery.

The benefits of robotic surgery

Robot-assisted surgery has many benefits. Patients experience these benefits both directly and indirectly. For example, because robot-assisted surgery is minimally invasive, a direct benefit to you is a shorter recovery time. And because the surgeon has better access to the operative area, an indirect benefit is a more precise surgery.

Other benefits include:

  • Smaller incisions
  • Greater range of motion and dexterity for the surgeon
  • High-resolution, the highly-magnified image of the operating field for better visualization during surgery
  • Shorter hospital stay
  • Lower risk of infection
  • Reduced risk of blood loss
  • Faster recovery with less pain
  • Minimal scarring
  • Better clinical outcomes

In addition, due to the enhanced control, flexibility, and precision that robot-assisted surgery offers, surgeons can complete complex or delicate procedures that may be difficult or impossible with traditional surgery.

Am I a candidate for robot-assisted surgery?

Although robotic surgery offers excellent outcomes for many patients, not everyone is a good candidate. The patient is recommended against robot-assisted surgery if:

  • You’re unable to have general anesthesia
  • You have significant scar tissue or other issues that prevent the cameras from visualizing the surgical area
  • You’ve been diagnosed with bleeding problems that put you at risk for surgery
  • You’re not a candidate for laparoscopic surgery

After a full evaluation of your condition and overall health, the surgical team in charge will determine if robot-assisted surgery is right for you.

What Are the Advantages of Robotic Surgery Over Laparoscopic Surgery

Robotic surgery is a minimally invasive surgical technique that uses a robotic arm to perform surgery.

The robotic arm is controlled by the surgeon, who sits at a console and uses a joystick to manipulate the arm. This allows the surgeon to perform surgery with greater precision and dexterity than is possible with laparoscopic surgery.

If you are considering robotic surgery, here are some things you can expect:

  1. You will be given general anesthesia, which will put you to sleep during the surgery.
  2. The surgeon will make a small incision in your abdomen and insert the robotic arm.
  3. The surgeon will then use the robotic arm to perform the surgery.
  4. The surgery will typically take less time than traditional open surgery.

You will likely be able to go home the same day or the next day after the surgery.

Overall, robotic surgery is a minimally invasive surgical technique that offers several advantages over laparoscopic surgery. If you are considering surgery, talk to your doctor about whether robotic surgery is a good option for you.

Advantages of Robotic Surgery

Here are some of the specific advantages of robotic surgery over laparoscopic surgery:

  1. Improved visualization: Robotic surgery provides the surgeon with a magnified, 3D view of the surgical site. This allows the surgeon to see more clearly and make more precise movements.
  2. Greater dexterity: The robotic arm has a greater range of motion than the human hand. This allows the surgeon to reach areas that would be difficult or impossible to access with laparoscopic surgery.
  3. Tremor-free movements: The robotic arm is tremor-free. This means that the surgeon can make very precise movements without the risk of shaking.

As a result of these advantages, robotic surgery has been shown to have several benefits over laparoscopic surgery, including:

  • Less pain: Robotic surgery is associated with less pain and a shorter recovery time.
  • Lower risk of complications: Robotic surgery is associated with a lower risk of complications.
  • Better cosmetic outcome: Robotic surgery is associated with a better cosmetic outcome.

However, it is important to note that robotic surgery is not always the best option for every patient. Some patients may be better suited for laparoscopic surgery or traditional open surgery. It is important to discuss your options with your doctor to determine which type of surgery is right for you.

Colorectal Surgery

What are types of colorectal surgery?

Colorectal surgeries are of various types depending on part of colon or rectum removed.

Types of colorectal surgeries are –

  1. Hemicolectomy – removal of half of colon – right or left
  2. Segemental resection of colon – removal of part of colon
  3. Subtotal colectomy – removal of whole colon leaving small part behind
  4. Total colectomy – removal of whole colon
  5. Proctocolectomy- removal of whole colon and rectum
  6. Anterior resection – removal of part of rectum
  7. APR – Removal of rectum and anus.
  8. Rectopexy for rectal prolapse

 All these are types of surgeries done for various indications –

  1. Cancer of colon
  2. Cancer of rectum
  3. Colitis
  4. Benign tumor of colon or rectum.
  5. Colonic perforation
  6. Diverticulitis
  7. Rectal prolapse

What is Colorectal surgery recovery time?

Laparoscopic colorectal surgery  is gold standard in today’s time. Open colorectal surgery is thing of past these days. Just like laparoscopy is gold standard for gall bladder removal, laparoscopy is gold standard for colorectal surgery. since introduction of laparoscopy in colorectal surgery recovery time has decreased considerably and patients are usually discharged from hospital within 3-5 days as compared to 7-10 days after open surgery. Patient is able to eat and move around early as compared to open surgery.  Shorter hospital stay also decreases cost of colorectal surgery. 

Risks involved in colorectal surgery?

Various risks involved with colorectal surgery are

  1. Bleeding after surgery – very rare
  2. Leak from anastomosis ( joints of intestine)
  3. Infection
  4. Injury to ureter ( urine pipe)
  5. Urinary bladder disturbance due to nerve injury ( especially after rectal surgery)

Upper GI Surgery

Upper GI Surgery is a subspeciality of GI Surgery. An upper GI surgeon is a doctor
who specializes in the surgical treatment of diseases of the upper gastrointestinal
tract. This includes the esophagus, stomach, and duodenum. Upper GI surgeons
also perform surgery to treat conditions of the liver, pancreas, and gallbladder.
Upper GI surgeons are trained in gastrointestinal surgery, but they also complete a
superspeciality training in upper GI surgery. This allows them to learn the latest
techniques and procedures for treating diseases of the upper gastrointestinal tract.
Upper GI surgeons play an important role in the diagnosis and treatment of diseases
of the upper gastrointestinal tract. They can provide a variety of services, including:

  • Diagnosis: Upper GI surgeons can perform a variety of tests to diagnose
    diseases of the upper gastrointestinal tract. These tests may include upper
    endoscopy, esophagogastroduodenoscopy (EGD), and barium swallow.
  • Treatment: Upper GI surgeons can perform a variety of surgical procedures to
    treat diseases of the upper gastrointestinal tract. These procedures may
    include fundoplication, gastrectomy, esophagectomy,
    cardiomyotomy, gastrojejunostomy, etc.
  • Follow-up care: Upper GI surgeons can provide follow-up care to patients who
    have had surgery or other treatment for diseases of the upper gastrointestinal
    tract. This care may include monitoring for recurrence of disease, providing
    support for patients and their families, and referring patients to other
    specialists as needed.

If you have any concerns about your upper gastrointestinal tract, it is important to
see an upper GI surgeon. Upper GI surgeons can provide you with the care you
need to stay healthy.

Here are some common conditions that upper GI surgeons treat:

  • Gastroesophageal reflux disease (GERD): GERD is a condition in which
    stomach acid backs up into the esophagus, causing heartburn and other
    symptoms.
  • Peptic ulcer disease: Peptic ulcer disease is a condition in which an ulcer
    forms in the lining of the stomach or duodenum.
  • Esophageal cancer: Esophageal cancer is a cancer that starts in the esophagus.
  • Gastric cancer: Gastric cancer is a cancer that starts in the stomach.
  • Achalasia cardia
  • Benign and malignant tumors of the esophagus and stomach.
  • Esophagus and gastric obstructions.

If you have any of these conditions, it is important to see an upper GI surgeon.
Upper GI surgeons can provide you with the care you need to stay healthy.

 Hepato Biliary Surgery

What is hepato biliary system?

Hepatobiliary system involves combination of liver and its ductal system(hepatic ducts, bile duct and gall bladder) draining bile (juice secreted by liver) from liver to intestine.

What are diseases that can affect hepatobiliary system that require surgery?

Hepato biliary disease treatment is best achieved by multimodality approach with involvement of Medical gastroenterologist, Interventional radiologist and Hepatobiliary surgeon. Diseases that require surgery are

  1. Liver cancer
  2. Cysts of liver
  3. Cancer from other organs that have spread to liver
  4. Stones in liver and bile duct ( can be treated with endoscopy also)
  5. Neuroendocrine tumor in liver.
  6. Liver abscess
  7. Tumors of bile duct ( cholangiocarcinoma)
  8. Gall bladder cancer
  9. Shunt surgery for bleeding varices;
  10. Bile duct stricture and fistula

How hepatobiliary surgeon can score over general and oncosurgeons in treating these diseases?

Hepato biliary system is very complex system that involves not only dealing with liver but also its complex blood supply and bile ductal system. As surgery is main modality of treatment so every effort is made to convert the unresectable tumors to resectable stage with help of radiology and other interventions. This is possible only if case is initially assessed by hepatobiliary surgeon who can plan resection in such a way that tumor is also removed completely and adequate amount of liver is also left that is compatible with survival.

How much liver can be removed safely?

In patients with normal liver around 75% of liver can be removed safely and person can lead normal life. However in case of diseased liver e.g cirrhosis , jaundice etc ,more amount of liver needs to be left behind for person to lead normal life.

Is it safe to operate on patients with jaundice or with liver disease?

Before operating upon patient with jaundice every effort is made to lower jaundice by various means e.g stenting, putting catheter in liver to drain bile duct. After bilirubin decreases to near normal levels then surgery is planned.

Why liver or biliary surgery complex?

Liver is a solid organ in which complex network of small bile ducts and blood vessels are hidden. Also bile duct and blood vessels are very closely associated outside liver. So tumors of liver and bile duct very commonly involve these blood vessels thus making surgery complex. Moreover as they are hidden inside liver, surgery is planned by preoperative imaging and intraoperative marking that is possible for surgeon regularly involved in doing hepatobiliary surgery. These planes have to be followed otherwise lot of bleeding can happen that is dangerous for patient.

Who should consult hepatobiliary surgeon?

Any patient suffering from any of diseases mentioned above should always consult hepatobiliary surgeon before starting upon any form of treatment. As assessment by hepatobiliary surgeon increases chance of cure by resecting even advanced tumors.

Do hepatobiliary surgeon treat gall baldder diseases also?

Yes. Gall bladder is an important component of hepatobiliary system is most commonly diseased organ due increased prevalence of stone disease. Hepatobiliary surgeon treats gall bladder diseases more effectively as he is ready for all surprises that can be encountered with gall bladder diseases that are not detected before surgery e.g complicated gall bladder disease, ruptured gall bladder detected during surgery, gall bladder cancer detected during surgery etc. Hepatobiliary surgeon would be able to deal with all this during surgery.

Does hepatobiliary surgeon treat CBD Stones also?

Majority of stones in bile duct are managed by endoscopy done by medical gastroenterologist but in some cases stones are very large in size and are very high in numbers then surgery can be better choice of treatment in form of removal of stones or providing bypass to prevent recurrent stone formation.