Minimal Access Thoracic Surgeries

Laparoscopic and Robotic Surgery

Minimal access surgery means a way of surgery where large incisions are avoided. This can be done either with the help of robot or with the help of a camera unit and instruments inserted into the body cavities with small incisions often 5mm or 10-12mm in length.

The advantage of minimal access surgery is less pain after surgery, early recovery of bowel function and chest function, shorter hospital stay. In certain cases, minimal access has an edge over the traditional open surgery for eg. Rectal cancer surgery, endometrial cancer in females. Several abdominal cancers and chest cancers can be treated using minimal access surgery.

Laparoscopic Surgery for Colon (large bowel) and Rectal Cancer

There is a vast amount of scientific research which supports the use of laparoscopy for operating colon and rectal cancer. Majority of the colorectal cancer world over are now treated by laparoscopic or robotic method. The pelvis is a confined space where operating is difficult due to lack of space. But in laparoscopy, the magnification and illumination make the surgery much easier.

Both in colonic surgery and rectal surgery, removing the tumour with all its layers (mesorectal and mesocolic fascia) with good margins of normal bowel is extremely important. This can be achieved accurately with the help of laparoscopy.

Due to the advantage of vision, magnification and instrumentation, it is possible to avoid a permanent stoma even in rectal cancers that are very low lying.

Laparoscopic Surgery for Gynecological Cancers- Cancer of Cervix and Uterus

Cancer of the uterus or endometrial cancer usually affects the menopausal females, who are usually overweight and have other risk factors like diabetes, hypertension. Surgical treatment of cancer of uterus requires removal of the uterus, both the fallopian tubes and both ovaries.

Along with these the lymph nodes which drain lymph fluid from uterus also have to be removed for they may also contain cancer cells. In such scenarios, the laparoscopic approach ensures less pain, early recovery especially in females with other risk factors like high blood pressure, diabetes etc.

Laparoscopic Surgery for Kidney and Bladder Cancer

Early-stage kidney cancer and bladder cancer are amenable for laparoscopic surgery.

Laparoscopic Surgery for Tumours arising in the Tail of the Pancreas

Tumours arising in the tail of the pancreas can often be removed laparoscopically. Laparoscopic pancreatic surgery is a complex procedure with a steep learning curve. Open pancreatic surgery requires a long incision in the upper abdomen. Such large incisions afftect respiratory recovery after the surgery. Not to mention the pain and delayed recovery. With laparoscopic surgery, all these issues can be addressed with ease.

Other uses of Laparoscopic Surgery

VATS – VIDEO ASSISTED THORACOSCOPIC SURGERIES

Similar to laparoscopic surgeries, thoracoscopic surgery means using a camera unit and instruments inserted into the chest through several small incision, rather than one large incision to carry out a surgery ( image). Open thoracic surgery requires a large incision and sometimes removal of one or two ribs. This entails a significant amount of pain and respiratory dysfunction. Whenever thoracoscopic surgery is feasible it leads to less pain and better functional recovery.

Thoracoscopic Surgeries for Mediastinal Tumours

Thymomas are the most common tumour arising inside the middle portion of the chest cavity ( called mediastinum). They can grow to a large size and sometime may turn malignant. However in most of the cases these can be removed by the thoracoscopic method.

Thoracoscopic Surgeries for Esophagal Cancers

Oesophagus is the food pipe which starts at the neck and is situated behind the windpipe and heart inside the chest, finally meets the stomach in the abdomen.

Cancer of oesophagus requires partial or total removal of the food pipe. And after the removal, the stomach below is connected to the small remnant of oesophagus either in the neck or in the chest.

This essentially means that the surgery happens in at least two places : abdomen and chest ( sometimes also in the neck). If the chest cavity part of the surgery is done by thoracoscopy it greatly improves the recovery and pain control for the patient.

ROBOTIC SURGERY

All the surgery that can be done laparoscopically can be done by robotic surgery as well. The robotic system provides a stable platform, dexterity, 3D vision with magnification and does not require a surgical assistant for vision.

For pelvic surgeries, it appears that robotic surgery might provide better preservation of nerves which control bowel and bladder function, in turn, leading to better sexual function, bowel bladder control after surgery.