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Operation Change

Minimal access surgery is an accepted modality for benign surgery.

Written by Anuradha Mascarenhas | Pune |
March 14, 2012 1:24:13 am

Robotic surgery is an emerging field with rapid acceptance owing to its wide range of benefits

Minimal access surgery is an accepted modality for benign surgery. Despite the advantages of laparoscopy,its acceptance in oncology is slow. Robotic surgery is an emerging field with rapid acceptance because of the 3-dimensional image,dexterity of instruments and autonomy of camera control.

Dr Shailesh Puntambekar,founder of the Galaxy Laparoscopy Institute,says,”Before we embarked on to robotic surgeries,we were performing advanced laparoscopic oncological procedures. The benefit of the robot lies in seven degrees of freedom due to the intra-abdominal articulated instruments,3–D vision,better alignment of eye hand instruments,recovery of control of camera by surgeon and downscaling the amplitude of motions and eliminating tremor.”

In oncology,the most important factor is oncological clearance which translates into survival benefits. The initial experience of using robotics in various oncological procedures,have shown comparable results with laparoscopy. Randomised control trials will help to decide gold surgical standard of various solid tumors,” he adds.

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The 3 Arm Da Vinci robot system (Intuitive surgical) was introduced in Galaxy Care Laparoscopy Institute in November 2009. Surgeons performed 164 oncological surgeries from November 2009 to June 2011. The surgeries performed included thoracic,colorectal,hepatobiliary,gynaecological and urological system. Puntambekar,founder of the Galaxy Care Laparoscopy Institute,reported the experience of using the Da Vinci robot for oncological procedures in the medical journal of Indian Association of Surgical Oncology recently. He pointed out that it changed surgical outlook from “big surgeon,big incision” to the “best surgeon,no incision”

Dr Geetanjali Agarwal explains,”Minimally invasive surgery was introduced more than 15 years ago. In order to maintain the advantages of minimally invasive approach but to avoid the restrictions of laparoscopic surgery,robotic surgery is emerging as a reliable surgical option that can achieve the same results of laparoscopic surgery.”

Doctors however have pointed out that there are limitations. Problems like learning curve,the lack of propioception,spatio-temporal awareness and haptic feedback,the compromise of hand eye co-ordination,the restricted degree of movement and lack of correct ergonomics for surgeons have prevented its widespread adoption in oncology.

The first robotic surgery was performed in 1988. Robotic system was used mainly for prostatic surgery and in the field of thoracoscopic beating heart surgery. It facilitates the advantages of open surgery while refining the minimally invasive techniques. Robotic surgery techniques claim to overcome the difficulties encountered in traditional laparoscopic surgery and thus make difficult minimally invasive surgical procedures easier.

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