The secrets of robotic surgery
Written by:Robotic surgery: the revolution of the last twenty years. Dr. Giovanni Butturini, an expert in General Surgery in Verona, describes this technique in detail, especially in the treatment of pancreatic cancer
Robotic surgery of pancreatic tumors
The pancreas is a deep organ in the abdomen, behind the stomach and at the front of the spine, which supervises functions of sugar metabolism with the production of insulin, and digestion of food through the enzymes that process the nutrients that we produce with food. Like all organs of our body, it becomes ill with inflammatory diseases, pancreatitis and cancer diseases. The pancreatic neoplasms are essentially divided into exocrine or endocrine depending on whether they originate from the exocrine component, the one that produces the digestive enzymes, or from the endocrine one, the one that produces the pancreas hormones. Furthermore, neoplasms can be solid or cystic. Through robotic surgery we can treat both benign neoplasms and malignant neoplasms, among the latter, the most frequent is ductal adenocarcinoma, which has an incidence of 15 new cases per 100,000 inhabitants per year. The safe causes of cancer are cigarette smoking, obesity and familiarity. A case out of 10, in fact, occurs in areas of familiarity. Regarding the onset symptoms of pancreatic cancer, they are mostly devious and justify the often late diagnosis of the tumor and that 70-80% of the patients seen at the first diagnosis, is no longer liable to radical intent surgery. Despite this, in bad luck it may happen that there is the lucky event that the neoplasm, albeit small, blocks the mouth of the common bile duct with the duodenum and then the patient becomes yellow, alliterate. In this case there can be a diagnosis even in a fairly early stage and these are the cases in which, most of the time, it is possible to resort to radical intent surgery.
The minimally invasive technique
Since the mid-90s the pancreas has begun to operate with the minimally invasive technique: real surgery that is done without fully opening the abdominal wall. In fact, incisions are made and trocar instruments are introduced which in turn allow the operator to introduce pliers, scissors and coagulators from the outside, looking at a video in the patient's anatomical situation. This technique, around the years 2000, has been implemented robotic technology. The robot is therefore not a tool that works alone, but is a technological tool in the hands of the surgeon who has helped and increased the possibilities of minimally invasive laparoscopic surgery. The advantages of this technique are: the fact that the patient does not undergo large laparotomies for access to the pancreatic organ (it can be reached with incisions around the centimeter, or 5-7 mm), an operating room is created at the inside the patient's abdomen with what is technically called the pneumoperitoneum, ie the insufflation of air, and then the operator can work on it inside. The benefits for the patient are not only aesthetic, but also functional, so we will have a faster recovery in post-operative of their vital functions, digestive functions and nutrition, less pain post-operatively resulting in less use of analgesic drugs, which in turn, it speeds up the functions of the intestine. It also reduces respiratory infections, the discharges are earlier, allowing the patient to quickly resume his usual activities.
Which tumors can be operated with the minimally invasive technique?
This technique is suitable for all types of tumors, including adenocarcinoma and is performed under general anesthesia. The data show that the oncological safety of this technical approach to pancreatic cancer is adequate and comparable to that obtained with open technique intervention. Therefore, from the oncological point of view, the same results can be guaranteed to the patient as they are with the open technique. These are obviously complex interventions, which must be done in centers with experience and which can give the patient the advantage of starting the cancer therapy necessary after the removal of the tumor quickly: the faster the recovery, the faster the possibility of starting the post-operative chemotherapy.
What advantages does the minimally invasive technique have?
Furthermore, this type of robot approach allows for cases of less aggressive tumors, such as endocrine tumors, such as insulinoma (small functioning tumors), the advantage of minimally invasive: smaller incisions, faster recovery and faster convalescence. Furthermore, tumors can be removed by sparing the surrounding healthy parenchyma or the organs near the pancreas like the spleen which, unless it is necessary for oncology removal, is a great advantage for the patient, not just at a young age, but for all patients who are left in place. With the minimally invasive robotic technique, the preservation of the spleen is easier, it is smoother and occurs in a higher percentage of patients. In conclusion, it can be said that the robotic approach to the pancreas is a positive evolution that has brought great benefits to the patient. It is widespread throughout the world and in Italy and every day allows us safe interventions with the satisfaction of our patients.