Robotic Surgery In Gynaecological Oncology

Robotic or Computer Assisted Surgery is a technological advancement that uses robotic systems to aid surgical procedures. This is an evolution of Laparoscopic Surgery and has been developed to overcome difficulties of conventional Laparoscopic Surgery. It is important to note that the surgery is performed by the surgeons and not the Robot. The robotic arms are only for assistance and are incapable of independent movement during the surgery. So through out the surgery, the surgeon is in control of the instruments and the procedure and not the Robot.

Before the widespread use of Robotic Surgery, Gynaecological Cancer Surgeries were performed by two approaches: Conventional Open Surgery and Laparoscopic (Key Hole Surgery).

Open Surgery has its own disadvantages - big scar, prolong recovery, more complications and long hospital stay. To overcome this, Laparoscopic surgery (Key Hole) Surgery was introduced, where the operations are performed through smaller incisions, which resulted in less blood loss, small scars, faster recovery and shorter hospital stay. The laparoscopic surgery has its own disadvantages and is very challenging to perform complex cancer surgeries. Hence, Laparoscopic Surgery was widely used for simple indications, but its use in complex cases was very limited.

Robotic Surgery is a perfect combination of both Conventional Open Surgery and Laparoscopic Surgery. The surgery is performed through keyhole just like laparoscopic surgery, but the instrumentation and the vision is totally different. The Robotic Surgery instruments are Wristed, which means they have a similar flexibility like human wrist as against laparoscopic surgergical instruments where the movements of instruments are restricted. The vision for the surgeon is Three Dimensional (3D), while in conventional laparoscopic surgery it is two dimensional 2D. Three-Dimensional vision is just like what you see in Open Surgery; hence the surgical precision is more with less trauma. This combination of wristed instruments, three dimensional vision, 12 times magnification, makes it a safer alternative to conventional laparoscopy. Also, it makes performance of complex surgeries much easier.

With the robotic surgical systems, the surgeon operates while seated comfortably in the console having a magnified 3D vision .The surgeon moves the masters in the console which translates his/her hand/wrist movements into precise, real time micro movements of surgical instruments inside the patient. The technology provides the surgeon with improved dexterity, magnification and camera stability. The arms remain steady all the time during surgery. The moment surgeon takes his head out of the console, all the instrument movements stop. So all the aspects at all given times are controlled by the surgeon and the Robotic System only works as an assistant throughout the surgery.

Robotic Assisted Surgery can be used to perform:

• Endometrial Cancer Surgery (Cancer of Body of Uterus)
• Cancer Cervix: Radical Hysterectomy
• Pelvic Exenteration
• Radical Trachelectomy
• Restaging Surgery for Endometrial/Ovarian carcinomas.

The current data that is available, Robotic Assisted Surgery is equivalent to conventional Open/Laparoscopic Surgery in terms of adequacy of dissection, lymph node retrieval and complications. The conversion rates are actually less with Robotic Surgery than Laparoscopic Surgery. Available data suggests that, Robotic Surgery can be safely recommended to all suitable women with Gynaecological cancers.

With the current available evidence, it can be safely assumed that Robotic (Computer) Assisted Surgery is a safe and viable alternative to Conventional Open and Laparoscopic Surgery. Robotic Surgery provides distinct advantage over Conventional Laparoscopic Surgery as the vision and instrumentation is superior to that used in Laparoscopy. It is important to note that, not all gynaecological cancer patients can be operated using this technique, but a select group of patients can definitely be benefited.