Open vs Laproscopic vs Robotic Surgery

Surgery is always a bold decision not only for you but for your treating surgeon as well. The magnitude of cancer surgery is definitely different and higher compared to the routine surgical procedures that one may have heard of. The end point of surgery for both, you as a patient and for your surgeon, is an optimum recovery.

Surgery puts you out of action for quite a while depending on your disease status and thus makes you think about your recovery and how painful will it be or how long will it take for you to get back to your day-to-day activities.

What surgery is right for me?

Surgery is usually done one of two ways:

  1. An open surgery which is done through a large cut /incision on your body
  2. A way in which there are no major cuts but just multiple button holes through whole certain instruments are passed in your body and filled with gas to create a working space for the instruments. This type is surgery is called Minimally Invasive surgery, as the invasion is though minimum cuts/ holes. The two ways in which minimally invasive surgery is done are: 1) Laparoscopy  and 2) Robotics

The debate between selecting these are usually when we are dealing with surgeries for the abdomen, pelvis and /or the chest.

 

So what is open surgery?

As the name implies, open surgical procedures are done through a large, open cut in the skin of the abdomen or the chest. While this can be done safely and effectively, the larger incision may take a little longer to heal and increase the length of hospital stay by 3-4 days. This method has been the traditional teaching and is still the standard for any cancer surgical procedure. It simply means that one will not go wrong in their decision in selecting a procedure by open method.

     

Some are concerned that an open surgery will lead to more pain but modern anaesthetic techniques such as epidural catheters (pain relieving medication is given through these thin catheters at the back) help to a great extent in relieving pain. Of course the cut may seem to be large but remains hidden at the abdomen or the chest under the clothes.

What is laparoscopic surgery?

Laparoscopic surgery is a minimally invasive procedure that uses several small cuts in the skin to access the surgical area. The surgeon uses a tiny camera called the laparoscope to view inside the abdomen or the chest. This laparoscope is manually controlled by the assistant and specialised instruments are then used through the small button hole sized cuts which are controlled by the surgeon to perform the surgery. Some gas is insufflated to bloat the abdomen so as to enable space to perform the procedure. This gas is removed at the end of the procedure.

One of the important aspects of cancer surgery is that the cancer specimens are usually large as it involves clearance of large areas to avoid cancer cells coming back. How do these specimens come out of the body through these tiny button holes? So here it is: the end result of the laparoscopic surgery involves a cut on the body to remove the organ or the specimen. This cut is however smaller compared to cut of the open surgery.

What is Robotic surgery?

It is better to term this as Robotic-assisted surgery, as the procedure is assisted most of the times with a laparoscope. This also uses small incisions similar to laparoscopy. The difference is instead of the surgeon using their hands to manually control the camera and instruments; they use the power and precision of a high tech machine which is called “Robot”. The surgeon sits at a console and uses controls to manoeuvre the instruments which are now called robotic “arms” during the procedure, allowing for more precise movements. The camera used in robotic system is High definition 3-D imaging which also allows for a bigger and better view of the operation.

So does minimally invasive surgery score over the open technique? Answer is Yes and No.

Yes, when it comes to recovery, because the cut is smaller and handling of tissues is minimal and intestines don’t remain exposed to outside air and hence the recovery time is faster by 2-3 days, the pain is lesser and you don’t need epidural catheters and the magnification provided and coupled with artificial intelligence can give better outcomes.

No, when it comes to cost, because laparoscopic and robotic instrumentation adds on to the cost of the surgery plus the time taken to perform a complex cancer surgery by laparoscopy and robotic approach may be comparatively longer. The insurance companies have yet not completely approved the costs involved in these high end robotic surgeries. Nevertheless the applications of minimaly invasive surgery in cancer are expanding by the day.

Roles of each of these minimally invasive techniques is being regularly evaluated in various cancers in comparison to the open surgeries and though there have been debates of one scoring over the other in different aspects of recovery, the minimally invasive surgeries haven’t proved to be inferior to the open techniques.

The dictum is that you should go by what your Surgeon is most comfortable at! Leave it to the Surgeon and his Surgical Expertise to make a decision on the type of surgery. Your surgeon knows what he is best at and what, that he can offer would give you the best outcome.