Minimally Invasive Robotic and Laparoscopic Gastrectomy: A new ray of hope for gastric cancer

The stomach is a muscular J-shaped sac-like structure, mainly acts as reservoir for the food, located in the upper and left part of abdomen and a crucial part of the Digestive organ of gastrointestinal system. It produces enzymes (Substances that create chemical reactions) and acids (digestive juices). This mix of enzymes and digestive juices breaks down food so it can pass to our small intestine(duodenum)

Gastric cancer, also referred to as stomach cancer, can happen anywhere, in any part of the stomach (Fundus, Body, also called proximal stomach and Antrum and Pylorus also called Distal part of stomach)– where abnormal growth of malignant cells, invading the stomach and adjacent and distal organs like Liver Lung, peritoneum and Bone etc
Symptoms of Gastric Cancer
The prominent symptoms of gastric cancer include:
•         Difficulty swallowing
•         Feeling full or bloated even after eating small amounts of food
•         Heartburn or acidity
•         Indigestion coupled with nausea and vomiting
•         Severe pain in the stomach
•         Unintentional weight loss
 
Causes of Gastric Cancer
There is no definite reason for what could cause stomach cancer. However, the risk factors that can trigger this ailment include
•         Chronic Gastroesophageal Reflux Disease
•         Overweight
•         Consumption of low fibre diet
•         Poor eating habits like intake of food high on salts, deep fries
•         Family history
•         Infection with Helicobacter pylori
•         Chronic gastritis
•         Smoking
•         Stomach polyps
Diagnosis
The diagnosis of gastric cancer is made by running various tests, including blood tests, and imaging tests like endoscopic ultrasound, CT, PET-CT, biopsy, or Diagnostic Laparoscopy
 
Treatment
Surgery forms the first line of defence while combating gastric cancer (in early stages). In the last decade, the surgical techniques for treating stomach cancer have grown by leaps and bounds, providing significant relief for the patients Treating gastric cancer requires the exceptional expertise of Surgical oncologists (gastro intestinal surgeons) Over the last decade or more, the surgical treatment for gastric cancers witnessed unparalleled medical advancements, with the advent of minimally invasive procedures like Robotic, Laparoscopic Procedures that ensure a faster recovery. 
 
What is Gastrectomy
Gastrectomy is defined as a full or partial removal of stomach for treating various medical conditions mainly for cancer
Gastrectomy is of four types – Total Gastrectomy, Subtotal Gastrectomy, Distal gastrectomy extended total gastrectomy (removal of distal food pipe) and Proximal gastrectomy
 
Advantages of Minimally Invasive Robotic, Laparoscopic Gastrectomy Procedures
Open surgery, laparoscopy, or Robotic Surgery; the principles involve the same – removing cancer and surrounding structures (in case of metastasis) without compromising on the cure. Minimally invasive surgical procedures provide a better outcome than open surgery in patients undergoing gastrectomy to treat gastric cancer. Extensively trained Gastrointestinal surgeons adopting either robotic or laparoscopic surgeries to ensure faster, safe and feasible alternatives to conservative open surgery.
Some of the advantages of minimally invasive procedures are:
•         Decreased postoperative pain
•         Shorter hospital stays and quicker recovery
•         Minimal scarring
•         Less strain on the immune system
•         Smaller incisions
•         Less chance of infection and hernia formation

How Is Laparoscopic Gastrectomy Performed?
Laparoscopic Gastrectomy is a widely recommended and adopted minimally invasive surgical procedure for eliminating cancer cells, even in the locally advanced stages of gastric cancer.  
During the procedure, several small incisions (key holes) are made by the surgeons. Surgical instruments are sent inside for accessing the diseased part for its dissection and removal. The surgery aimed at eliminating the cancer cells, may take a little longer in comparison to open gastrectomy but the patient would recover faster due to less blood loss and pain. It has 2D vision and Ergonomics of instruments are difficult due to straight instruments
The patient would be able to resume regular duties and eat normally within a week or too
 
How Is Robotic Gastrectomy Performed?
Robotic-assisted gastrectomy is done by making a small incision (key hole) measuring up to 8 to 12mm, at the belly button and three other small incisions for assistant instruments at the upper abdomen. The surgeon sits at the console during the procedure, directing the robotic arms to perform the operation. These robotic arms work like human hands with absolute, accurate dexterity, finger movement, and wrist (done by surgeon hand actions transmitted through instruments with digital interactions). Even while performing the surgery, the surgeon could view a magnified, high-definition 3D view of the organs, enabling the surgeon to execute procedures like dissection, bowel connections, and stapling.
The advantages of Robotic Gastrectomy are aplenty. It is often recommended for removing Gastrointestinal stromal tumours, gastric adenocarcinoma, or even rare form of carcinoid or neuroendocrine tumours.
This procedure has lesser pain when compared to conventional open gastrectomy. Other benefits include:
•         Lesser blood loss and less transfusions
•         Reduced risk of infections
•         Early starting of feed
•         Faster return to normalcy
Since its inception, robotic surgeries have been carried out extensively in thousands of procedures across the globe. These techniques have gained widespread popularity for its positive impact on a patient’s recovery, fewer complications, and shorter stays at hospitals. If we focus on cancers in particular, these surgeries are widely used in the treatment of gastrointestinal cancers. To learn more about the benefits of robotic surgeries for gastric cancer care, you can consult an oncologist for further guidance.

Authored by:
Dr. Jagannath Dixit, Surgical Oncologist, HCG Cancer Centre, Bengaluru