Cooperman, Steele, Wayne M.D (Biliary and Pancreatic Surgery of New York)
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Robotic Surgery – Liver, Pancreas, and Stomach

Surgical treatment remains a sole option when your disease turns serious and does not respond well to less invasive treatments such as medications and lifestyle changes. However, recent advances in medical technology have brought in revolutionary techniques that make surgical procedures less traumatic. One such advancement is the robot assisted surgery which is a type of minimally invasive surgery.
Robot-assisted technology is a way where the computer controlled robots are utilized in performing surgeries to obtain more precision and accuracy. The robotic arm serves as an extended hand for the surgeon and provides greater range of motion and dexterity. Robot assisted surgical system can replace traditional open surgical techniques recommended for hernia, spleenectomy, colostomy closures, and various other surgeries. This surgical system provides the surgeon with unique precision to perform different procedures. It gives a three-dimensional view of the surgical area with improved magnification and precise robotic movements. The robot assisted surgical system comprises four different parts — a surgeon console, a computerized control system, two instrument “arms”, and a camera.
During robot assisted surgical procedure, your surgeon will make small incisions or ports near the surgical site. Surgical instruments, attached to the robot’s arms and a tiny camera are inserted through these ports. The camera placed inside the patient helps your surgeon to obtain a three-dimensional image of the surgical site. Your surgeon will use the robot’s arm to control any placements and movements of the surgical instruments.
Being a minimally invasive approach, robot assisted general surgery offers the following benefits:

  • Lesser risk of complications
  • Smaller incisions leading to reduced scarring and minimal blood loss
  • Less post-operative pain
  • Shorter hospital stay and recovery period
  • Faster restoration to normal activities

Robotic technology has been widely used in medical fraternity for various conditions including the gastrointestinal conditions such as the conditions of liver, pancreas and stomach.

Robotic stomach surgery

There are different conditions related to stomach, for which the robot-assisted surgery is being used.

  • Total gastrectomy for cancer
  • Gastric resection
  • Wedge resection
  • Gastric by-pass

Depending on the condition from which the patient is suffering, different surgical methods are being employed.

Total gastrectomy includes complete removal of stomach and a reconstruction of Roux-en-Y esophagojejunostomy with anastomosis between esophagus and the jejunum using artificial structures (enteroenterostomy). Total gastrectomy is indicated in individuals with big tumors or malignant lesions in the upper portion of the stomach.

In traditional open surgeries, a long midline incision will be made in the abdomen which was a highly invasive procedure with high post-operative risks and discomforts. This new technology, using gastric resections have minimal invasion and proved to be very safe, minimal discomforts and a promising approach for various cancers.

Gastric resection is a treatment approach for bleeding ulcers and tumors of the stomach. In this procedure large part of the stomach secreting the acid will be removed.

Wedge resection is the removal of a mass of timorous tissue in the stomach.

Gastric by-pass is indicated in obese people as a weight-loss surgery. In this procedure the stomach will be divided into upper part and lower part and then an anastomosis will be established bypassing the major part of stomach as well a part of small intestine. This reduces the size of stomach and as well the food intake.

Robotic pancreatic surgery

Various pancreatic conditions that can be treated with robotic surgery include:

  • Distal splenopancreatectomy
  • Distal pancreatectomy with spleen preservation
  • Enucleation of pancreatic tumors

Robotic procedures have proved to be very effective and precise alternatives to open surgery. Earlier these procedures were confined to few specialized centers because these procedures require highly skilled surgeons and also surgeons had many technical difficulties. But with the advent of robotic surgeries surgeons are able to overcome these limitations. It has made possible for surgeons to perform complex and advanced procedures with high precision and minimal invasive approach. In addition, surgeons can more comfortably operate by using robotic control consol, having 3-D view from cameras, instead of those long awkward positions with 2-D images in open surgery.

In this technology, surgeons can increase the depth of 3-D perceptions and can also control the motion of the camera for better results. The advantage of robotic technology in pancreatic surgery over traditional open surgery is:

  • Better micro-dissection of the major vessels for spleen-preservation
  • Superior suturing
  • Minimal blood loss
  • Better lympadenectomy with improved radicality
  • Minimal surgical trauma

Robotic liver surgery

Surgery has become the major part of treatment, for patients suffering from primary or metastatic liver cancer. As liver is the located in the upper quadrant of the abdomen a very large incision is required for the surgery. However this has been greatly reduced by adopting new robotic surgery technology. Different procedures carried out using robotic technology for liver conditions include:

  • Hepatic lobectomy – Removal of one of the two lobes of liver
  • Liver wedge resection – Tumor removal with portion of liver
  • Liver segmentectomy – Removal of one of the eight segments of liver

The advantage of robotic surgery is that they avoid large incision, and also helps in removing complex or critical tumors which are otherwise, very hard to do with tradition open surgery methods. As we know that, liver is one of the highly regenerating organ of our body and by employing robotic surgery techniques, one can easily remove complex tumors with minimal discomfort without affecting its regenerating power.

Robotic technology has also been successfully used in liver transplantation, which has made liver transplantation very simple with fewer complications.

Cooperman, Steele, Pacholka, Wayne M.D (Biliary and Pancreatic Surgery of New York) - Multimedia Patient Education
 

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