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Robotic Surgery to Make Tumor Removal Less Harsh
등록일 : 2017-06-28 01:11 | 최종 승인 : 2017-06-28 01:11
Anne Taylors

[리서치페이퍼=Anne Taylors 기자]

Photo source: Cmglee via Wikimedia Commons

Robotic surgery now makes removing tumors of the bowel (rectal cancers) much less harsh and not quite as invasive.  The innovative new procedure done by way of robotic surgery is extremely accurate and allows for far less surgical trauma as well as smaller incisions, which will also increase recovery time.  This is because of a better 3-D viewpoint to the operating area and the robotic precision to perform the surgeries in the small crevices of the lesser pelvis and in doing so will achieve top notch surgical results. 

The Comprehensive Cancer Center (CCC) of MedUni Vienna and Vienna General Hospital has been certified by the European Academy of Robotic Colorectal Surgery (EARCS) since the beginning of the year.  The robotic colorectal surgery program is the first center for robotic colorectal surgery in Austria.

In Austria, every year about 1,100 people are diagnosed with rectal cancer, with a third of the 1,100 being diagnosed as a low-lying tumor.  That describes a tumor located at the very end of the colon.  The end of the colon is an extremely challenging location for even high-level surgeons because they are difficult to access.  It is an anatomically restricted area to work with, in which the view is especially narrow.  Adding to this complex issue is the fact that the surrounding neuroplexis is very dense and also sensitive, which means nerve damage, can easily result in sexual function and possibly incontinence.

Rectal tumors up until this point were done as an open surgery, one that is basically categorized as a 'major operation', which is burdensome, to say the least for patients considering the size of the wound.  Although for the last few years doctors have had the ability to use laparoscopy which is a 'keyhole' surgery and is a better alternative to an open surgery.  However, unfortunately, the 'keyhole' surgery is only able to be performed on 30 percent of all patients with rectal cancer.  Also, there is a high risk of urgently needing to switch from 'keyhole' to 'open' surgery in the middle of the procedure.  When this happens complications become much more prevalent.

Photo source: Robert Shields via Wikimedia Commons

The robotic method or robot-assisted method is the newest step in minimally invasive colorectal surgery.  In using this method what happens is the surgeon will control a 4-armed robot capable of performing surgical maneuvers.  While guiding the robot the surgeon can view an enlarged 3-D image of the whole operating area.  The surgeon is provided with 7 different angles that have optimal visibility that allows for a nerve saving and extremely accurate operating technique.  This also serves the purpose of less blood loss than laparoscopy.  Additionally, studies have shown this procedure to be more ergonomic for doctors, while being even easier to learn the process of using the method than laparoscopy.  So we can see the poignant advantages the robotic method provides as opposed to open surgery or laparoscopy, specifically with the lower pelvis and the constricted space it has.  The new method has also already been used for prostate removal surgeries as well as in the gynecological field.

The two go to experts when it comes to colorectal robotic surgery at the CCC, Thomas Bachleitner-Hofmann and Michael Bergmann (Department of Surgery of MedUni Vienna/Vienna General Hospital, Head: Michael Gnant), estimate that it will be used to perform around 90% of all rectal surgeries in future.

The European Academy of Robotic Colorectal Surgery (EARCS, Homepage: www.earcs.pt) is providing special training courses to comprehensively train surgeons in the use of the new method.  This is being done to maintain patient safety and assure uniformed treatment standards.  At this point in time, only 25 doctors in all of Europe are certified and trained in the new method.  "Especially in specialist centers, robotic surgery should be the standard procedure for removing a colorectal tumor, since it has clear advantages over the other methods, particularly for low-lying rectal cancers.We are proud to be the first center in Austria to have obtained certification to perform robotic colorectal surgery."  Bachleitner-Hofmann said.

Bachleitner-Hofmann and Bergmann are the first two Austrian surgeons to be certified.

Moving forward the CCC will continue the monitor the procedure on an ongoing basis.  Then it has plans to perform a fatigue study (surgical fatigue) evaluating the positives of the robotic surgery in comparison to the two common procedures.  They will use certain types of parameters to determine the ability to concentrate and physical fitness levels before and after performing each of the methods.  Bergmann stated: "As an academic institution, comprehensive scientific validation of the new method is important to us.Our impression is that the fatigue factor is significantly less for the surgeon when he/she uses the robot.This is presumably due to the better ergonomics of the robotic method.We also want to establish this scientifically.It has already been demonstrated on many occasions that adequately rested doctors contribute to increased patient safety.That would then be an added advantage of this technique."

The future looks bright for the colorectal surgery world.

[리서치페이퍼=Anne Taylors 기자]
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