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Head & Neck Cancer (Trans-Oral Robotic Surgery (TORS)

Head and Neck Cancers in the region of pharynx (tonsil, base of tongue, etc) and larynx (voice box) are usually treated with chemotherapy with radiation which has severe lifelong morbidity or side effects. Many patients suffer from difficulty in swallowing, sever dry mouth, narrowing of throat and chronic pain due to the side effects of chemotherapy and radiation to head and neck. Trans-oral robotic surgery is a unique form of surgery that is possible only because of developments in robotic technology. TORS is surgery is performed through mouth without cutting the patient's skin. In selected patients TORS alone may cure the cancer.

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Prostatic Cancer

Prostate is male sexual glans located deep inside the hip bone. This deep position of the gland makes it one of the most difficult organs to reach in open surgery. Cancer of prostate is common and occurs mainly in older age group. This cancer is mostly curable by surgery when the disease is limited to prostate. The procedure is called radical prostatectomy. Today this procedure is performed robotically. Robotic radical prostatectomy has become standard of care for prostate cancer. Robotic surgery gives better surgical outcomes than open or laparoscopic radical prostatectomy

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Rectal Cancer

Rectum is the last part of the intestine where the stool is stored and passed out of the anus. When rectal cancer is located low down close to the anus (sphincter) that controls the bowel movement, the anus used to be removed along with the cancer which meant that the patient got permanent colostomy…. Not anymore. ….the techniques and technology have made in possible to save the sphincter in mare patients than ever before. Robotic surgery has changed this as it makes it possible to go very low down into the pelvis and do a good cancer surgery and still save the sphincter. Many patients can benefit out of robotic ultralow anterior resection or inter-sphincteric resection.

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Pancreatic Tumours (Obstructive Jaundice)

Robotic whipples procedure or pancreaticoduodenectomy is performed for cancers of duodenum, perriampullary cancers, pancreatic cancer or bile duct cancer (cholangiocarcinoma). The key to a successful Whipple's surgery is in the technique of re-joining (reconstruction) of pancreas with the intestine. We follow the modified Hindenburg technique whether we perform the surgery open, laparoscopically or robotically. Though some centres today perform the surgical removal of the tumor by laparoscopy, the reconstruction is performed using an opening in the abdomen. The introduction of robotics makes this surgery possible to be performed by minimal access with quick recovery and least pain.

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Esophageal cancer

Esophagus or food pipe is carries food from neck to stomach. Cancer of oesophagus and gastroesophageal junction cancer is common. The surgery involves removal of oesophagus with good enough tumour free margin along with lymph nodes. Lymph nodes are filters that trap the cancer cells. Lymph nodes are a common site of cancer recurrence. The most extensive surgery for esophageal cancer involves removal of lymph nodes called extended 2 field and 3 field lymphadenectomy. Robotic Esophagectomy improves the removal these lymph nodes, makes it more accurate. The 3D vision and dexterity of the robotic arms improves the surgeon's ability to take out the cancer.

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Gynaecological Surgeries

Removal of uterus and ovaries is required for various reasons. Cancers of ovary, endometrial cancer or cancer of uterine cervix are the most common cancers where surgery is needed. All these surgeries need extensive removal of lymph nodes to give good cancer results. Also uterus being an organ deep inside the pelvis is better handles by the minimally invasive technique of robotic surgery. Robotic para-aortic lymph node surgery and pelvic lymph node surgery give excellent results. Robotic radical hysterectomy is a standard procedure with excellent results due to the dexterity offered by the da Vinci robotic system.

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Thyroidectomy

Thyroid is a gland in front of the neck. A traditional surgery for thyroid needs a wound in front of the neck often making an ugly scar. Robotic thyroidectomy practice by many centres across the world involves a large wound in the armpit or back of the neck in order to just avoid a scar in front. This is called remote access thyroidectomy as the wound is away from the front of neck. What we practice is robotic minimal access thyroidectomy using da Vinci robot wherein the wounds are tiny. The surgical steps and results are similar, but the recovery and the wound healing is much better.

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Robotic Surgery for Other Cancer

Scope of robotic surgery is wide. We have been performing laparoscopic surgeries for many cancers over the years. However, what robotics has done is it has improved the quality of surgery in certain areas where open as well as laparoscopic surgery had found some difficulties. Robotic surgery can be used in most of cases where laparoscopic surgery is used. However, there are some distinct advantages when it comes to certain surgeries. Mention of all cancers is beyond the scope of this website, however, some more surgeries that are worth a mention include.

Kidney Tumors for which robotic partial nephrectomy could be performed. Gastric or stomach cancers can be treated using robotic surgery. Robotic hempectomy for liver cancers are very effective way to treat liver tumors and cancers.