Chapter 3.3 - Robotic surgery in cancer

Abstract

Cancer is responsible for the death of thousands of people around the world. When diagnosed and treated at an early stage, long-term survival rates are very high, and today advanced screening has considerably improved early cancer detection and diagnosis. The contemporary view is that surgical cancer removal should also aim at minimizing the external and internal trauma to the patient, for improved postoperative healing and cosmesis. Toward these two goals, minimally invasive surgery (MIS) approaches strive for organ-sparing—as opposed to radical—surgery, using miniaturized surgical instruments introduced through small incisions on the patient skin, or through natural orifices. The operational challenges of such approaches are obvious. Robotic surgery, still in its infancy, is known to improve surgical practice. However, certain operational challenges remain and clear long-term evidence about the superior curative outcomes of robotic surgery over conventional approaches is a subject of debate. This chapter introduces MIS, discusses its limitations for both conventional and robotic approaches, and highlights future opportunities for improving surgical outcomes. Gastrointestinal cancer surgery is used as a representative case study.