Robotic Hepatopancreatico Biliary and GI Surgery

Minimal invasive surgery became reality in early 1990 and it has evolved in the last 30 years that it has replaced many open procedures. The first robot-assisted surgical procedure was done in 1985 (PUMA 560 robot) was used in a neurosurgical biopsy. FDA approved the da Vinci Surgery Robotic System in 2000. The da Vinci robotic surgery system had three-dimensional magnification screen, which gave the high-resolution view of the operative field. The “Endo-wrist” features of the operating arms gave the 360 degrees like movement as wrist which was lacking in laparoscopic surgery. 

The robotic-assisted surgery now is being used for diseases and conditions including cancer surgery. In robotic surgery, the surgeon controls telescope-like instruments from the console. The surgeon sees the surgical field on a high definition screen in three dimensions, which is on the console. With the robot, surgery can is done more accurately and with greater precision. 

Use of robotic surgery has been expanded and now hepatopancreatic biliary surgery is also being performed by this technique. Safety is increased by better 3D vision, approach to deeper and difficult places, which are difficult to reach by laparoscopic or open methods and 360-degree movement of the robotic arms. 

Why robotic surgery?

Conventional open surgery is the technique is performed by a team which include many surgeons and assistants. It involves incisions, which causes tissue damage, postoperative pain and more chances of adhesion formation after surgery. It further causes a longer hospital stay.

Robotic surgery is technical advancement in which surgery is done by a few small holes in the abdomen and it can reach to the difficult areas of the body. It causes less tissue trauma, less pain and recover is faster after surgery.

Diseases for which robotic surgery can be done

  • Biliary disease (Gallstone disease, Gallbladder mass or polyp, Biliary stricture, Bile duct tumour – cholangiocarcinoma, Choledochal cyst)

  • Liver cystic lesions (simple cysts and hydatid disease)

  • Liver masses (Focal nodular hyperplasia - FNH, Liver adenoma, Liver hemangioma, Hepatocellular carcinoma - HCC, Metastatic tumors - Colorectal cancer and Neuroendocrine tumor)

  • Pancreas cysts neoplasms and masses (Simple serous cystadenomas (SCN), Intraductal pancreatic mucinous neoplasm - IPMN, Mucinous cystic neoplasm – MCN, Pancreas neuroendocrine tumor - PNET, Pseudopapillary tumor, Adenocarcinoma)

  • Pancreatitis (Pseudocyst, Chronic pancreatitis)

  • Stomach conditions (Gastric cancer, Gastrointestinal stromal tumors - GIST, Ulcer disease, Gastric outlet obstruction)

  • Colorectal disease -Cancer of Colon and rectal, Benign conditions of colon and rectum, Diverticulitis, Inflammatory bowel disease, Crohn’s disease of the duodenum, small intestine, colon, rectum, and anus, Ulcerative colitis to a restorative total proctocolectomy, Rectal prolapse.

  • Oesophagal disease- Esophageal cancers, Achalasia cardia, Gastroesophageal reflux disease

Procedures which can be performed by robotic surgery

  • Liver or Hepatic surgery - Right and left hepatectomy, Left lateral hepatectomy, Right and left trisegmentectomy, Nonanatomical resections

  • Biliary surgery - Biliary bypass, Choledochal cyst excision, Cholecystectomy, 

  • Pancreatic surgery - Whipple’s procedure, Distal pancreatectomy, Pancreatic pseudocyst drainage, Pancreatic enucleation

  • Splenectomy

  • Stomach surgery - Radical gastrectomy, Gastrojejunostomy (bypass to stomach for blockage), Surgery for esophageal reflux disease (Nissen fundoplication), Heller’s cardiomyotomy

  • Colorectal surgery - Surgery for colon and rectal cancer (right and left hemicolectomy, Sigmoidectomy, Low anterior resections, Abdominoperineal resection), Ileal pouch-anal anastomosis, subtotal colectomy and rectopexy.

  • Esophageal surgery- Esophagectomy for cancer of the esophagus, Heller’s cardiomyotomy

Risks of robotic-assisted surgery

Risk is the same as open surgery and it can be minimized by preoperative assessment of a patient’s overall health. 

Advantages of Robotic surgery

Advantage of robotic-assisted is there over open surgery.

  • Less pain

  • Less blood loss

  • Better cosmetics

  • Smaller incisions

  • Shorter hospital stay

  • Faster recovery 

 

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