Within the last few years, a paradigm shift has occurred in the operating room: surgeons no longer need to directly touch or even see what they are operating. Endoscopic video imaging and advanced in instrumentation have converted open surgeries to endoscopic ones. This has resulted in higher survival rates, fewer complications, and a quicker return to daily activities.
“Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly ‘noninvasive’ surgery will be a reality” (JAMA).
In addition to a speedier recovery and increased survival rate, “the pain, discomfort, and disability, or other morbidity as a result of surgery is more frequently due to trauma involved in gaining access to the area to perform the intended procedure rather than from the procedure itself” (JAMA).
Minimally invasive surgery began in the fields of gynecology and orthopedic surgery, and is now found in “general surgery, urology, thoracic surgery, plastic surgery, and cardiac surgery” (JAMA).
Some simple surgical procedures have been performed by a “robot”, or rather, a surgeon acting remotely. However “there is no clear path to practical application at present because of expense, transmission delay, and medical and legal issues” (JAMA). Rather than remote manipulation, robots used today gather information, assist with navigation, and enhance the surgeon’s dexterity. For example, during a retinal vein thrombosis surgery, the surgeon inserts a thin tube (100-micron), using the help of robotics. This technique is not possible without such dexterity enhancement.
Minimally invasive radical prostatectomy (MIRP)
Prostate removal can be performed via an opening in the abdomen (RRP) or by a minimally invasive and more costly MIRP. From 2000 to 2006, there was an increase of robotic-assisted MIRP from 1% to 40% on radical prostatectomies. A 2009 study, published in the Journal of the American Medical Association, compared the effectiveness of these two surgeries. It found that people who had the minimally-invasive surgery had a shorter hospital stay, fewer complications and strictures, but experienced more urinary and genital complications, including incontinence and erectile dysfunction.
The study concluded that RRP, “with a 20-year lead time for dissemination of surgical technique relative to MIRP, remains the gold standard surgical therapy for localized prostate cancer.” However the distinction should be made that RRP is the gold standard, not invasive surgery as opposed to minimally invasive surgery. The study praises the use of minimally invasive surgery for many diseases, but says that RRP is better in this case because it is performed through a small hole, rarely causes significant pain, and results in only a 1-3 day stay in the hospital.
Minimally Invasive Check for Lung Cancer
Lung cancer is the most common cause of death by cancer in the United States. For many patients with suspected lung cancer, surgery is the only method to confirm the diagnosis.
A study published in The Journal of the American Medical Association in 2008 compared the accuracy of three minimally invasive techniques to confirm lung cancer diagnosis. The results of the study can be found here. The significance of the study for our purposes is to showcase the capabilities of minimally invasive surgery, especially when the correct diagnosis of cancer rests in the balance. “Accurate staging [diagnosis] of lung cancer is critical for choosing optimal therapy” (JAMA). Therapies include surgical removal of cancerous lymph nodes and/or chemoradiation, depending on the type of lung cancer diagnosed.
The Mayo Clinic
The Mayo Clinic, the largest not-for-profit group practice in the world, is well respected in the medical community. Many physicians there use minimally invasive surgery, also known as laparoscopic surgery, as “the preferred surgical approach for many illnesses.” They have one of the largest minimally invasive surgical practices in the nation.
The Mayo Clinic is using robotic surgery, which it calls “an advanced form of minimally invasive surgery,” increasingly to aid the surgeon’s views and precision. They have pioneered many advances in both minimally invasive and robotic surgery.