Robotic surgery throws up images of scalpel-wielding androids making precise little incisions, and the truth is not far from it. The robotic arms manoeuvring the tiny surgical instruments are remotely controlled by a highly-trained surgeon from a console across the room.
It’s a bit like watching a video game while a skilled gamer expertly hacks and snips life-eating tissue away to save the life of the target, who, in this case, is a patient with prostate cancer.
The surgeon is Dr Ashutosh Tewari, the director of the Institute for Prostate Cancer, at Weill Cornell Medical College in New York. One of the world’s leading experts on robotic surgery, he has done over 3,500 of them to remove walnut-size prostate affected by cancer, which is among the top five cancers globally.
Dr Tewari controls the movements of the adjustable robotic arms with the surgical instruments using joysticks and pedals even as the two hour surgery is projected real-time on a 3-dimensional screen through a camera inserted through a tiny incision in the patient’s abdomen.
You can watch him reach inside the body, cut open the surrounding tissue, cut out the prostate and sew everything back with minimal bleeding. So clean was the procedure that the patient walks within hours of surgery and is discharged the next day.
As in any other treatment, how successful the surgery is depends on the surgeon’s skill, though the robotic technique reduces hospital stay by accelerating recovery. “The robotic technique improves dexterity, reduces operating-room fatigue and increases precision by removing the slightest of hand tremors even while it enhances visualisation,” says Dr Tewari, who gave a live demonstration of the surgery at the Inaugural International Prostate Cancer Symposium in New York last month.
Held at the New York Academy of Medicine, the first-of-its-kind symposium had international experts from 70 countries discussing all aspects of the cancer, from basic science research to cutting-edge treatment. Dr Anthony D’Amico from Harvard University in Boston, UK’s Dr John Fitzpatrick, the editor-in-chief of the British Journal of Urology International, and Dr Mani Menon, chair of the urology department at Henry Ford Hospital in Detroit, were among those who debated the pros and cons of open, laproscopic or robotic surgeries, along with other treatment options such as radiotherapy, immunotherapy and chemotherapy. The final treatment depends on how much the cancer has spread, the patient’s age, and the presence of other disorders, such as diabetes or obesity. The enhanced precision and magnification of the robot allow surgeons such as Dr Tewari to develop new techniques — such as the one for nerve-sparing — that cure with minimal side effects, such as incontinence and impotence after surgery.
Experts at the symposium, however, did not reach a consensus on whether robotic surgery was better than open or laparoscopic surgery. “Skilled surgeons get results irrespective of the type of surgery and until randomised clinical trials are done, we cannot say one technique is better than the other,” concluded Dr Fitzpatrick.
But with 80% prostate cancer surgeries in developed countries done using a robot, it’s clearly the new path to cure.