Laparoscopic Surgery in Oncology, Rectum and Use of Robotics

 

The hypothesis according to which the pneumoperitoneum favors the seeding of the abdominal cavity by malignant cells, has demonstrated by study. Laparoscopy is ultimately only the first approach and that as long as the principles of oncological surgery applied and considered in oncological surgery. Laparoscopy results respected and are identical to open surgery. The hypothesis, according to which laparoscopy would provide better results, remains to be demonstrated.

However, and despite recent technological developments, some indications remain controversial, either because of too high technical requirements, or because of the lack of scientific validity.

For a large number of reasons use of simulators is a prudent choice like Laparoscopic Needle Holder.

Advanced Laparoscopic Surgery in Oncology

Rectum

While the benefits of laparoscopic colectomy surgery for colon cancer have demonstrated by prospective randomized studies. The value of laparoscopic treatment of rectal cancer only based on cohort studies and the results of a large prospective study are not will only be released next year at best. Lacy et al. analyzed20 patients operated by laparoscopy. They showed a conversion rate of 30% (44 patients), with a postoperative morbidity of 5.4%, including 6% of anastomotic leaks.

Postoperative mortality was 9% and the mean hospital stay of 8 days. These data confirm the feasibility of this intervention, the main results of which come from specialized centers. To summarize the data from the literature two recent Meta-analyzes. Laparoscopy was associated with a reduction in morbidity. It showed in a group of 85 patients that it is prolongation of operating times.

However, the rates of wound infections, anastomotic leaks, and mortality were similar in the two groups. On a group of 09 patients operated on by laparoscopy and162 patients in open surgery, collected in twenty studies. Demonstrated a reduction in hospital stay and resumption of transit in the laparoscopy group. During perineal exenterating, laparoscopy has reduced parenteral analgesia and the rate of wound infections.

Two Meta-analyzes did not reveal any difference in short and medium term survival in oncological terms. A single multicenter randomized study performed on the base of 42 patients, demonstrating a non-significant increase in radial resection margin positivity in the laparoscopic group, forcing the authors not to offer routine laparoscopy in rectal cancer. The surgeon oncology group is developing a new prospective randomized study in order to define the value of oncological safety and the feasibility of laparoscopy in the treatment of rectal cancer.

Future of Laparoscopic Surgery

Augmented reality and virtual reality

By integrating computer technologies allowing the production of images from radiology examinations, the target anatomical structures visualized intraoperatively. This superposition of images reconstructed on the base of preoperative CT-scan or MRI images will allow the surgeon to turn out to be effectively guided Combined with laparoscopy. Using this technique. Performed the first resection of the right adrenal gland with dissection in contact with the inferior vena cava.

Organ deformities by gripping, as well as the integration of the patient's respiratory movements are disruptive elements that make these techniques difficult and continue to be the subject of research.

The development of three-dimensional images also makes it possible to improve the speed of certain gestures such as stitches or ligatures.0 However, experimental data show that the image does not improve the precision of movement and increases the fatigue of the surgeon in these initial stages.

Robotics

Although integration into surgery is recent, robotics used in industry. The costs, as well as the heterogeneity of patients and pathologies have contributed to this delay. The Automated endoscopic system for optimal positioning (AESOP) was the first robot validated by the in 1993. The system allowed the laparoscopy camera to be maintained, and its movements were first controlled by a pedal and then by voice recognition.

This system had the advantage of a position memory and the absence of involuntary movements. However, it was not able to assist with the manipulation of the tissues or the performance of any part of the procedure. The development of this technology has made it possible to separate the operator from the direct handling of the instruments. The Zeus robotic system developed on the AESOP platform for positioning the camera and two additional arms, controlled by the surgeon via a console equipped with two joysticks and a screen.

Wearing polarized lenses made it possible to obtain D vision. More recently, the Da Vinci robot, comprising a binocular laparoscopic camera, allowing a translation computed in D images, and four working arms, offered new perspectives. The computer filters the operator's movements by suppressing unnecessary movements. This system validated in 2002 and has already been the subject of numerous clinical studies.

In 2001 performed the first colectomy with the Da Vinci robot. To date, the largest study, comprising 06 patients and comparing robotic colectomy and laparoscopy, demonstrates the absence of difference in operating time, in transit recovery time and in hospital stay. A second study involving seven patients recently demonstrated similar results, confirming the absence of robotics-related complications in their case-control study.

Demonstrated that robotic-assisted cholecystectomy had no clinical benefit over laparoscopy and resulted in a significant increase in costs due to the system itself and the single-use equipment required. The initial investment, as well as the maintenance costs are the main drawbacks, limiting the use of robotics. On the technical level, the absence of force feedback makes it possible to exert traction on the tissues, which can damage the intra-abdominal structures.

The difference between the “research” and “marketing” aspects of the manipulator robot and the real clinical utility remains to be analyzed in detail.

For more information visit our website: www.gerati.com