Dr Afsana Elanko
Director of Education, British Association of Surgical Oncology (BASO-The Association of Cancer Surgery)
Mr Jim Khan
Consultant Colorectal Surgeon, Clinical Director, Portsmouth Hospitals NHS Trust.
Trustee BASO -The Association of Cancer Surgery
Surgeons are integral to lead the technological advances for digital surgery.
Despite advances in chemoradiotherapy, surgery remains the main modality for treatment of resectable rectal cancer. The last decade has seen significant technological advances and treatment developments. Improved diagnostics, development of new surgical tools, and enhanced vision-systems have lead surgeons into the era of digital surgery.
Surgical innovation and robotics
“The surgeon” remains integral to improving the survival of colorectal cancer patients. Good quality surgery as a result of sound surgical technique leads to reduced local recurrence and improved survival.
The recent advances in technology and tools have allowed surgeons to use minimal access surgery and the laparoscope for Total Mesenteric Excision (TME) surgery. Some of the inherent difficulties of laparoscopic surgery such as 2D image, a fulcrum effect, limited access to a narrow pelvic area and amplification of tremor has been overcome by the increased use of robotic technology for TME surgery.
Robots offer a 3D view, along with endowrist instruments and stability of the operating platform. This precision allows surgeons to replicate the principles of open TME surgery in a minimal access fashion.
Developing the future
With significantly increased interest in use of robotics in general surgery, there are about 12 new industry-partners now investing in developing and creating new systems to launch over the coming years.
Apart from improvements in surgical navigation and imaging overlay, there is hope to use artificial intelligence to a level where the surgeon may oversee the performance of robotic platforms like the use of autopilot in the airline industry.
With the use of big data, machine learning and quantum computing, there is a potential for huge growth in this area. These newer robotic technologies are not cheap and the current systems are expensive to buy and run, as the cost of consumables remains high.
Investing for innovation
Investment in robotic surgery is allowing industry partners to develop technologies such as enhanced vessel sealing capabilities with energy sources, the use of fluorescence f vascular blood supply assessment and lymph node drainage.
The concept of surgical navigation is being developed, where the surgical oncologist will be guided by the tools available in robotic surgery to preform better cancer clearance and achieve improved survival for such patients.
We are entering the era of digital surgery where like our cars, home entertainment systems and phones, we will have many add-ons that will enable surgeons to perform complex cancer surgery safely with minimal collateral damage and improved survival for our patients.