Dr Puneet Ahluwalia

Robotic surgery: Boon for surgeon and patients alike

kapiluiux — Sat, 03 Jul 2021 06:30:01 +0000

Robotic surgery involves use of the da Vinci robot surgical unit in performing complex surgeries. Although Robot is used in multiple specialities for minimal invasive surgeries, urologic oncological surgical procedures are at forefront of the spectrum. Other specialities where Da Vinci robot has commonly been used include (but not limited to) gynaecological malignancies, thoracic procedures and bariatric surgeries. Urological cancer surgeries in which Robot is used include Robotic Radical prostatectomy (removal of the prostate gland usually for cancer), Robotic partial nephrectomy (surgical removal of tumor of kidney while preserving the normal part of kidney), Robotic Radical Cystectomy with Urinary diversion (Removal of cancerous urinary bladder while constructing the pathway for urinary passage by using part of intestines), Robotic Radical Nephrectomy (removal of whole of cancerous kidney when part of it can’t be saved), Robotic Nephroureterectomy and Robotic Adrenalectomy. Other major Uro-oncological procedures include Robotic Retroperitoneal lymph node dissection (for residual tumor in abdomen usually after chemotherapy for testicular tumor) and Robotic VEIL (video endoscopic ilioinguinal dissection). This exciting technology allows the operating surgeon to sit comfortably behind a console and control the robot that is next to the patient to perform surgery. The operating surgeon sitting on master console is in complete control of robotic instruments attached to robotic arms that have been docked to ports placed in patient’s abdomen. An experienced assistant surgeon assists the console surgeon from the bedside.

Most patients and physicians would agree that minimally invasive surgery is preferred over traditional open surgery techniques. All minimally invasive surgery techniques have similar benefits, such as less blood loss, reduced pain, smaller scars, shorter stay in the hospital and faster recovery times. However, sometimes patients have the choice between two minimally invasive surgery techniques: robotic surgery and laparoscopic surgery. There are some technical limitations to laparoscopic surgery which can make it difficult even for an experienced surgeon to work in certain scenarios. On the contrary, the technical advances with robotic surgery has enabled the surgeon to conduct surgery with previously unmatched precision under high-definition, magnified 3D vision.

Advantages of Robotic Surgery over Laparoscopic Surgery

Variable	Robotic	Laparoscopic
Vision and image	3D, magnified, high definition leading to increased accuracy and vision	Usually 2D
Who controls the Camera	Primary Surgeon	Assistant
Max number of instruments under control of primary surgeon(Main operating surgeon)	Can control four instruments including camera, hence better coordination	Only two instruments and hence dependency on assistant increases
Range of motion of instruments	Greater range of motion and hence precision	Limited range of motion
Level of dexterity	Highest possible; Robotic instruments can rotate a full 360 degrees and more flexible than a human hand or wrist	Limited range of motion
Ability to access hard to reach spaces	Incomparable; Robot can allow the surgeon to reach and operate in otherwise inaccessible areas	Much lesser than robotic
Suturing (stiches inside the body)	Much easier and faster reducing bleeding and surgical time	Much more time consumng and difficult, can affect the precision and surgical results

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Testicular Cancer in Indian Population

kapiluiux — Tue, 15 Jun 2021 06:20:01 +0000

India has one of the lowest incidences of testicular cancer with less than 1 man per 100, 000 population affected by this condition.

Signs and symptoms

Most common presentation is painless testicular mass.
Acute pain is less common and is either the result of bleeding within the tumor or due to rapid tumor growth.
Testicular cancer may also present as a incidental finding on ultrasound Incidental scrotal trauma is likely responsible for bringing the testicular mass to patient’s attention for the first time.
Approximately 2% of men affected have gynaecomastia (enlargement of male breasts).

Self Examination

Testicular cancer can be detected at early stage by doing monthly testicular self examination and feel for any lumps or abnormal enlargement as compared to the other side.

Risk Factors

Cryptorchidism (Undescended testis at the time of birth)
Family history of testicular cancer
A personal history of testicular cancer in the other testis
Infertile men have higher incidence of testicular tumor.

Cure rate

Most of the testicular cancers can be cured, even if the cancer has spread. For men with cancer that has not spread beyond testicles, the 5-year survival rate is 99%. For men with cancer that has spread to lymph nodes in the back of abdomen, called the retroperitoneal lymph nodes, 5-year survival rate is about 96%.

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Urinary Bladder Cancer

kapiluiux — Mon, 03 May 2021 05:41:18 +0000

Bladder cancer originates from the lining of urinary bladder which is an organ in your pelvic area that stores urine

Signs and symptoms

Clinical manifestations of bladder cancer are as follows:

Painless gross hematuria which means visible blood in urine – Approximately 80-90% of patients; classic presentation. It is important that even a single episode of hematuria (blood in urine) is not ignored.
Patient may present with Irritative lower urinary tract symptoms such as increased frequency, urgency and mild pain while passing urine. This can happen in 20-30% of patients.
Sometimes patient may present with advanced disease with symptoms related to involved distant organ. For example: spread in bones may present as pelvic or bony pain, lung involvement due to spread may present as cough.

Risk factors

Factors that may increase your risk of bladder cancer include:

Smoking
Increasing age : rarely found in people younger than 40.
Men are more likely to develop bladder cancer than women are.
Exposure to certain chemicals especially in rubber and dye industry.
Chronic inflammation. May cause squamous cell carcinoma
Personal or family history of cancer.

How is Urinary Bladder Cancer diagnosed?

Tests and procedures used to diagnose bladder cancer may include:

Cystoscopy.
Biopsy/TURBT
Urine cytology to look for malignant cells
Imaging tests. Ultrasound/ Contrast enhanced CT scan

Treatment OVERVIEW

The treatment, prognosis and follow up of urinary bladder cancer depends on stage (depth of the wall involved by cancer), grade of the disease(high grade vs low grade) and present of distant metastasis. Most of bladder cancers are diagnosed at early stage and thus are highly treatable. However even the early stage bladder cancers have high tendency to recur. Hence regular follow up is a must in a patient diagnosed with bladder cancer.

Superficial (Non muscle invasive) and low grade tumors may be treated with endoscopic surgery through the normal urinary passage which is called TURBT (transurethral resection of bladder tumor).
Muscle invasive bladder cancer/ Recurrent high grade non invasive cancers require removal of complete bladder surgically (Radical cystectomy) once muscle invasion is confirmed on TURBT. Radical cystectomy further involves creation of alternate passage for urine(Urinary diversion).
Patients with muscle invasive bladder cancer who are not fit or not willing for Surgery can be treated with Radiation therapy in conjunction with Chemotherapy.
Bladder Cancer which has spread to other organs of the body however is seldom curable and an effort is made to control the disease with Chemotherapy

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