All about robotic oesphagectomy
When treating oesophageal cancer, it is important to get rid of cancerous tissues and surrounding lymph nodes in order to cure and prevent a reoccurrence of the cancer. In this article, Mr Boz Mohammadi, an experienced consultant upper gastrointestinal surgeon explains the oesophagectomy, and how using robotic assistance to perform it is beneficial.
The oesophagus is the pathway from the mouth all the way to the stomach through which swallowed food travels. Cancer in the oesophagus is more common in people over the age of 60, and can be accompanied by symptoms such as difficulty swallowing, acid reflux, and pain along the throat.
What are the indications for oesophagectomy?
When oesophageal cancer is diagnosed in its early stages, patients may be able to be fully treated using endoscopic treatments. However, for further developed cancer, removal of diseased tissue will be more effective, sometimes combined with chemotherapy.
The removal of any portions of the oesophagus is referred to as an oesophagectomy. During this procedure, after the tissue has been removed, the stomach is commonly used to reconstruct the oesophagus.
What happens during a robotic oesophagectomy?
In traditional open techniques, all or a portion of the oesophagus are taken out through a cut in the neck, chest, stomach, or via a combination of any of those three sites. However, this technique leaves a lot of scarring and can be majorly traumatic to the surrounding tissues and structures; some surgeons may even need to break a rib to access the appropriate portion.
This is where minimally invasive approaches like robotic assistance can be preferable for patients. Robot-assisted surgery utilises a robotic console with specially equipped arms – one of which with a high-definition camera on the end. The procedure is however performed entirely by a skilled upper GI surgeon. This technique only requires a few small incisions through which the ultrafine tools can be passed through. These factors contribute to several patient benefits of robotic surgery, such as:
- Smaller, less noticeable scars
- Less blood loss during the procedure
- Less pain during recovery
- Reduced respiratory complications
- Faster recovery time, meaning patients can leave the hospital and return to their normal lives significantly faster
- Less disruption to the tissues
However, surgeons also benefit from using robots to conduct an oesophagectomy. Because the oesophagus traverses the entire torso, it is deeply intertwined with the intricate anatomy and excising any portions of it requires extreme precision and dexterity. Using the robotic console helps surgeons avoid strain during complex procedures, minimises errors and enables the surgeon to remove the cancerous tissues and surrounding lymph nodes with higher precision and accuracy. The high definition 3D views provides the surgeon with far more visibility than their regular eyes or even with a laparoscope. Sometimes, cancerous cells and tumours are in specific locations that cannot be safely or noninvasively accessed without the robot’s arms’ flexibility and reach.
What happens after a robotic oesophagectomy?
After a robotic oesophagectomy, patients typically stay in the hospital for recovery and monitoring for approximately a week, compared to two weeks in an open procedure. The entire recovery process is expected to last around two months, and patients should be aware that their dietary habits will be altered – they will have to eat smaller portions more frequently to accommodate their stomach or intestine’s altered size.