Robotic surgery now commonplace

Oncologist Dr. Troy Gatcliffe from Baptist Health South Florida has been practising robotic surgeries on gynaecological cancers for six years. 

While many people are familiar with the minimally invasive surgery technique of laparoscopy, Dr. Gatcliffe describes robotic surgery as “minimally invasive 
surgery 2.0”. 

The technique was approved in 2006 and is widely used in gynaecological and urologic operations. 

“The robot has its place, it will not ever be able to totally replace open surgery (laparotomy) technology, but it has become the standard of care for many, many patients that used to be treated with open surgery.  

“In gynaecologic cancer, there has been a complete paradigm shift now in the treatment of endometrial cancer. Endometrial cancer was typically always treated with open surgery because the hysterectomy, tubes and ovaries and the lymph nodes were sampled. In the States now, certainly in large cities, academic training centre, etc., almost all endometrial cancers that are confined to the uterus … are treated with robotic surgery,” 
Dr. Gatcliffe said. 

Endometrial cancers refer to malignancies that arise from the endometrium, or lining, of the uterus. 

Robotic surgery for gynaecological and urologic condition is so widely available across the United States, that Dr. Gatcliffe advises patients that if it is not offered to them by their doctor, they should look elsewhere for the procedure. 

The benefits that apply to laparoscopy surgery – smaller incisions, faster recoveries, less pain, faster return to activities of daily living – also apply to robotic surgery, but the robot gives the surgeon more control during the surgery. 

“The robot provides for better dissection, better visualisation,” Dr. Gatcliffe said. “The technology in the robot allows the surgeon to have a three-dimensional, high-definition view of the anatomy that’s not possible with standard laparoscopy.” 

Using the robotic technique, the surgeon sits at a console, looking through a viewfinder and using paddles that control the instruments of the robot, which is “docked” to the patient.  

“What the robot does that standard laparoscopy cannot do is it allows the surgeon to reach into spaces and places that heretofore were really not possible,” he said. “More importantly, the level of visualisation is so much more markedly improved over standard laparoscopy versus even laparotomy. 

“Laparotomy involves an incision, you’re looking at that cancer with your eyes, but you have to be sterile, so you can’t put your face up to the cancer. With the belly closed and small ports, you can put the camera right up to the cancer. What that means for the patient is that the surgeon can dissect cancer in a way that is at times not even possible with an open surgery, in places where he or she could never have put her view before. That translates to better dissection, better removal of cancer, better removal of lymph nodes and staging of cancer and less blood loss.” 

Using the robotic techniques, the surgery involves less movement of the surgical instruments around the port sites – or incisions – than in laparoscopy because the movements are controlled far more precisely when using the robot than if a surgeon were holding the instruments in his hands. 

“The patient has even less pain. What happens is, I perform a robotic surgery between 7 and 10pm one day. By the time I see the patient next day at breakfast time, she is already walking around her room, eating breakfast and asking when she can go home,” Dr. Gatcliffe said. 

The doctor visited Grand Cayman last week to speak at the Lions Club of Tropical Gardens and Baptist Health International’s Breast Cancer Survivors Breakfast on Saturday, 27 October at the Westin Casuarina 
Resort and Spa. 

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