Robotic Surgery over Open Surgery in treating Prostate Cancer

Dr Raghunath SK, Uro-Oncologist, HCG Cancer Hospital elucidates on the efficiency of deploying robotic technology by surgeons to perform complex surgical tasks through tiny incisions

Prostate cancer is one among the top 10 leading sites of cancers in India. Approximately 25,000 new cases of prostate cancers detected in men and around 17,000 deaths occurred due to the same every year (this is probably tip of an iceberg as the data is from the hospital registry). The cancer projection data shows that the number of cases will double in the year 2020. (*Globocan, 2018).

Though it is usually a very slow growing cancer and most patients do not have significant symptoms until the cancer reaches an advanced stage. Most men with prostate cancer die of other unrelated causes, and many never know that they have the disease to begin with. But once prostate cancer begins to grow quickly or spreads outside the prostate, it could compromise their quality of life and cost of treatment is very high and may not be curable.

Most surgeons and hospitals treating this form of cancer are slowly migrating towards robotic surgery rather than the traditional open surgery.

Surgery (removal of prostate-radical prostatectomy) is one of the common modalities of treatment to cure stage 1 and 2 cancers and some of the stage 3 cancers.

Surgery is performed by open, laparoscopic or by robotic methods.

Robotic Surgery over Open Surgery

Robotic surgery is an advanced form of minimally invasive surgery where surgeons use a computer-controlled robot to assist them in surgical procedures. The robot’s ‘hands’ have a high degree of dexterity, allowing surgeons to operate in extremely tight spaces in the body that would otherwise only be accessible through open surgery by using a long incision.

Compared to open surgery, robotic surgery uses smaller incisions resulting in less pain and scarring. This allows surgeons to perform complex surgical tasks through tiny incisions using robotic technology. The endo wrist movements at the tip of robotic arms, provides surgeons with seven degrees of freedom to have better accuracy and flexibility to preserve the nerves and urinary sphincter, that helps in early and better recoverability of sexual function and control over the urination respectively.

Benefits to surgeons:

Greater visualisation
Enhanced dexterity
Greater precision
Less physical wear and tear
Less fatigue
Improves efficiency.

Benefits to patients:

Shorter hospitalisation
Reduced pain and discomfort
Faster recovery time and return to normal activities
Smaller incisions, resulting in reduced risk of infection
Reduced blood loss and transfusions
Minimal scarring
Better preservation of sexual function and early control over urination.

Performing robotic surgery using the da Vinci Surgical System:

The surgeon works from a computer console in the operating room, controlling miniaturized master controls(similar to joy sticks).

He looks through a 3-D camera attached to a robotic arm, which magnifies the surgical site to upto 15 times to have the better vision.

His hand, wrist and finger movements are transmitted through the computer console to the instruments attached to the robot’s arms in real time to perform the surgery precisely and accurately.