Traditional Laparoscopic Surgery
Vs
Robotic Assisted Laparoscopic Surgery
Laparoscopic Surgery is superior to Robotic Assisted Surgery (RAS) in 98% of the operations. The only Robotic Assisted operation (RAS) that is better than standard laparoscopic surgery is prostate gland surgery.
Laparoscopic Surgery
Cosmetic MiniScarLess (MSL) Laparascopic Surgery for Heartburn, Hernia, Gallbladder and other diseases is an innovative approach that Professor Amir Nisar prefers to use as it is far superior to conventional laparoscopic & Robotic Assisted Surgery.
Keyhole (laparoscopic) surgery is performed through small cuts and has been practiced for more than 50 years, but for the last 30 years, it has become the standard practice in hernia, gallbladder, appendix, and many other common operations.
Laparoscopic/ Keyhole/ Minimal Invasive surgery is done by making 3-5 small cuts in the abdomen and placing 0.5cm to 1cm ports (plastic tubes) through the abdominal wall. These ports act as stable channels through which a camera can be placed to give an excellent high definition/ 4K / or 3D view of the abdominal organs. Instrument required to perform the operation are also passed in, removed, and changed through these portals.
Recovery is quick after Laparoscopic /Keyhole surgery as compared to an open operation. Return to work, post-operative exercise, and driving are better than an open operation as well.
Laparoscopic surgery/ MiniScarLess Surgery is offered by the surgeon standing himself by the patient’s side along with his team throughout the operation. Currently Laparoscopic surgery is the Gold Standard for most types of surgery, like Gall Bladder surgery, Nissen’s Fundoplication, Hernia Surgery (inguinal, Umbilical, Epigastric and incisional hernias) and Bowel Resection.
Robotic Assisted Surgery (RAS)
Robotic surgery is a misnomer; it is actually Robotic Assisted Surgery (RAS). In Robotic Assisted Surgery (RAS), surgical assistant and nurse stand alongside the patient in theatre, while the surgeon sits in a separate room on a console to directs the robotic arms for dissection and manipulation of tissue from distance. The surgical port sizes remain more or less the same in both approaches.
Robotic assisted laparoscopic surgery is performed in the same fashion as laparoscopic surgery. The robot is operated by the surgeon as a master slave approach. It is important to understand that its is not “Robotic Surgery”, as mostly sold to the patients; rather “Robotic Assisted Surgery”.
Benefits of Robotic Assisted Surgery
RAS (Robotic Assisted Surgery) has the advantage of offering more flexibility with the tips of the instruments, thus making some complex maneuvers easy for the surgeon in complex cases like radical prostatectomy. However, expert surgeons can perform these complex operations without any robotic assistance was similar ease.
Robotic-assisted laparoscopic surgery (RAS) is also helpful to train young and inexperienced surgeons in some complex surgeries like heart surgery or prostate gland surgery. Although Robotic Assisted Surgery (RAS) was commercially popular in the United States, but now its use has reduced. it has found much less popularity in the United Kingdom and Europe.
Currently Robotic Assisted Surgery (RAS) is helpful and used in procedures like Heart Surgery, Prostate surgery, Low Rectal Surgery and some Orthopaedic knee surgery. Its use in other forms of surgery is debatable and less preferable than standard laparoscopic surgery.
Disadvantages of Robotic Assisted Surgery (RAS)
Robotic Assisted Surgery (RAS) requires larger and more number of cuts than standard laparoscopic surgery. MiniScarLess Surgery (MSL) offers far superior outcomes than Robotic Assisted Surgery (RAS) in terms of cosmetics, less post operative pain, and quicker recovery for the patient.
There is clearly no role of Robotic Assisted Surgery (RAS) in general Laparoscopic operations like gallbladder surgery, hernia surgery, anti-reflux surgery, simple large bowel, oesophageal, stomach, or liver resection surgery for benign or cancer cases.
Instead, most experts in Laparoscopic surgery agree that robotic surgery is an overkill in such cases as patients require a longer need for anesthetic due to a longer operative time.
There seems to be more complications (sometimes life threatening) from Robotic Assisted Surgery (RAS) during its learning curve.
Increased cost remains another disadvantage with Robotic Assisted laparoscopic surgery (RAS).
Situations where Robotic Assisted Surgery (RAS) should not be used
There is clearly no role of Robotic Assisted Surgery (RAS) in general Laparoscopic operations like gallbladder surgery, hernia surgery, anti-reflux surgery, simple large bowel, oesophageal, stomach, or liver resection surgery for benign or cancer cases. Most surgeons agree that there is clearly no role of Robotic Assisted Surgery in General Laparascopic operations.
Comparison Table of various Techniques
(in order of preference)
| Gallbladder Surgery Technique | Total size of cuts | ||
|---|---|---|---|
| Cosmetic Mini Scar Less (MSL) Laparoscopic Cholecystectomy “Amir-Kennedy Cholecystectomy Technique” |
1.4cm | 14mm | 0.55 inch (Just over half an inch) |
| Needlescopic Cholecystectomy | 1.6cm | 16mm | 0.63 inch |
| Laparoscopic Cholecystectomy | 3cm | 30mm | 1.2 inches |
| Robotic Assisted Laparoscopic Cholecystectomy | 3cm | 30mm | 1.2 inches |
| SILS (Single Incision Laparoscopic Surgery) | 4.5cm | 45mm | 1.8 inches |
| e-NOTES (embryonic Natural Orifice Transluminal Endoscopic Surgery) |
4.5cm | 45mm | 1.8 inches |
| Open Cholecystectomy | 20cm | 200mm | 8 inches |