Pancreas cancer refers to the growth of abnormal cells in the pancreas or the development of carcinoma (cancer occurring in the tissues of one’s skin, organs, and internal passages) in the pancreatic duct cells or cells that produce pancreatic juice. Pancreatic cancer that starts in the pancreatic duct cells is called pancreatic ductal adenocarcinoma (cancer that starts in the glands inside the organ).
Pancreatic cancer is difficult to detect in the early stages because symptoms do not appear immediately. Even if symptoms are seen, they cannot be easily ignored. According to the US National Institutes of Health (NIH), some symptoms of pancreatic cancer are yellowing of the skin and eyes, weight loss, stomach and back pain, and fatigue.
Healthcare providers cannot easily see or feel the tumor during routine checkups because the pancreas is hidden behind other organs. A physical examination, imaging tests, blood tests, and biopsy can diagnose this disease.
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However, it is difficult to treat because it is not detected early and spreads rapidly. By the time it is detected, the cancer has spread over a large area.
Risk factors for pancreatic cancer are smoking, long-term diabetes, and hereditary disorders.
Pancreatic cancer can be treated through surgery, chemotherapy, radiation therapy, and targeted therapy that uses drugs to attack specific cancer cells.
An important technique for treating pancreatic cancer is robotic surgery of pancreatic tumors.
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Why is robotic surgery a good option for pancreatic tumor removal?
One of the most challenging and complex areas in general surgery is pancreas surgery. It is usually performed in an open manner due to the location of the pancreas, it is closely connected to the major vessel, and resection of the pancreas, which is a surgery to remove the head of the pancreas.
Robotic technology can be used to perform minimally invasive pancreas surgery. Compared to traditional open surgery, robotic surgery reduces the length of stay and reduces the chances of infection at the surgical site.
The military was interested in performing operations from a distance, such as near the battlefield, or in space, and this interest led to the development of robotic surgery. The US Department of Defense had completed much of the preparatory work.
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California-based firm Intuitive Surgical has developed a minimally invasive robotic surgery technology called the Davinci Surgical System.
According to the NIH, as part of this technology, a robot with three or four arms is operated by a surgeon who sits at a separate console. Many of the shortcomings of traditional laparoscopic techniques are overcome during robotic surgery. Actually, robotic surgery was developed to overcome the shortcomings of laparoscopic surgery. Laparoscopy is a surgical technique in which the surgeon can see inside the abdomen and pelvis without making a large incision in the skin because a small tube containing a light source and a camera is used.
Deficiencies that must be addressed during robotic surgery include limited freedom of movement, monocular vision, poor hand-eye coordination, and two-dimensional images.
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This is because during robotic surgery, the surgeon gets a three-dimensional stereoscopic (the brain’s ability to register a sense of three-dimensional shapes) view of the operating field. Robotic surgery also restores hand-eye coordination that is often absent in laparoscopic surgery because the camera comes in the same plane as the plane of dissection.
Endorist technology, which belongs to Intuitive Surgical, replicates the movements of the human hand with seven degrees of freedom, and also eliminates hand vibration.
Robotic surgery also allows the surgeon to tie knots easily.
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Some of the disadvantages of robotic surgery are that it is expensive, and many of the instruments are used only once.
The first robotic distal pancreatectomy was performed in 2001.
“Currently, robotic surgery is used for pancreatic resection and the treatment of pancreatic cancer in both the head and tail of the pancreas, as well as for drainage and resection procedures in chronic pancreatitis.” Dr Mahesh Thombare, Associate Professor, Surgical Gastroenterology, Dr DY Patil Medical College, Hospital and Research Centre, Pimpri, Pune, told ABP Live.
Redness and swelling of the pancreas is known as pancreatitis.
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How is robotic surgery done?
Before undergoing robotic surgery, the patient must not take any food or fluids for eight hours, and the person must stop taking aspirin, blood thinners, vitamins, supplements, and anti-inflammatory medications 10 days before the procedure.
As part of robotic surgery, very small instruments are attached to a robotic arm, which the surgeon controls with a computer.
The patient is given general anesthesia so that they fall asleep and do not feel any pain. Sitting at a computer station, the surgeon directs the robot’s movements.
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To insert the instruments into the body, the surgeon makes small incisions.
A thin tube with a camera is attached to the end of the robotic arm so the surgeon can see large three-dimensional images of the body while performing surgery. These can be viewed on a large monitor.
According to the NIH, the robot matches the movements of the surgeon’s hands.
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Once the robotic arm is placed in the abdomen, it becomes easier for the surgeon to use surgical instruments as compared to laparoscopic surgery.
Robotic surgery also offers a better view of the area where the surgery is performed.
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However, robotic surgery may take more time to perform than laparoscopic surgery because it takes a lot of time to set up the robot.
“Many types of pancreatic surgeries have been performed with robotic surgical systems. Large monitors are located throughout the operating rooms and within the computer console pods to show real-time, 3D-HD images captured by the cameras. When combined with the surgeon’s experience and training on the device, robotic arms provide greater speed and greater stability than human hands alone, making surgeries more precise and minimally invasive. Dr. Sachin Marda, senior consultant oncologist and robotic surgeon (cancer specialist), Yashoda Hospital, Hyderabad, told ABP Live.
While the main surgeon operates the robot from one station, an assistant surgeon and a surgical team remain near the patient so that they can constantly communicate with the main surgeon.
“An assistant surgeon is positioned at the bedside with the surgical team so they can constantly communicate, while a surgeon is positioned at the robotic console that controls the robotic arms. Inserting cameras and surgical instruments through small incisions allows better visibility. If necessary, the head of the pancreas and parts of the small intestine, gall bladder, surrounding lymph nodes and stomach can be removed using robotic surgical instruments controlled by the console surgeon. Dr. Marda said.
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What happens after robotic surgery?
The prognosis after robotic surgery is better than laparoscopic surgery or traditional open surgery. According to the NIH, patients recover faster, are less likely to get infections, have smaller scars, have less pain and bleeding, and have shorter hospital stays.
“It has been observed that with robotic surgery, patients recover faster, have less pain, require less painkillers and return to their regular lives sooner. Even though it takes longer, patients benefit greatly from the smaller incisions and better visibility, including faster recovery time, less blood loss, less bruising, less chance of wound infection, less pain and, therefore, pain. This includes less need for medication. Dr. Marda said.
After robotic surgery is complete, the patient is taken to a recovery room, where they may stay overnight or for a few days, depending on the type of surgery.
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Within a day after the procedure, the patient should be able to walk. The way the surgery is performed determines how soon they will be activated.
Patients should avoid heavy lifting or straining until their surgeon tells them otherwise. Also, they should not drive for at least a week.
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