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Evolution of MedTech in advanced surgical robotics in Uro-Oncology

Specific to Urology, data from a landmark study shows that around 62% of the diseases associated with nephrology and urology are caused by underlying non-communicable diseases like diabetes, cardiovascular disease, chronic respiratory diseases, etc.

MedTech
A key area of focus in uro-oncology has been cancer of the prostate, a leading cancer amongst men in India.
By Mandeep Singh Kumar,

The last few years have pushed the medical and technological boundaries to find appropriate solutions for accelerating preventive and curative measures for non-communicable diseases with varying degrees of success. Oncology is one such area that has got considerable attention – and rightfully so.

Specific to Urology, data from a landmark study shows that around 62% of the diseases associated with nephrology and urology are caused by underlying non-communicable diseases like diabetes, cardiovascular disease, chronic respiratory diseases, etc. In comparison, 27.5% are caused due to communicable diseases like microbial infectious diseases, urinary tract infections, etc.1 In 2020, the projected number of incidence cases of prostate, kidney & urinary bladder cancers were more than 85,000 in India.

A key area of focus in uro-oncology has been cancer of the prostate, a leading cancer amongst men in India. While it usually affects men in the age group of 65+ years 2, in recent years, there has been an upsurge in cancer cases among younger males, particularly in metropolitan areas.

The range of treatment options available and 5-year survival rate in men diagnosed with prostate cancer is directly correlated to the stage of disease with a nearly 100% survival rate for early-stage prostate cancer. However, in India, the 5-year survival rate for prostate cancer is 64%. This difference is indicative of late diagnosis and a lack of awareness of appropriate treatment options among the Indian population. This, coupled with limited infrastructure, has significantly increased the burden of the disease among patients.

To enhance awareness and promote early diagnosis and better treatment outcomes, the month of September has been commemorated as an uro-oncology month with a particular focus on prostate cancer. Uro-oncologists are trained to identify and treat these conditions by removing the affected organ while carefully sparing unaffected areas. Surgery often is the primary treatment for many urologic cancers. If urologic cancer has metastasised, treatment may also include chemotherapy, radiation therapy targeted therapy, or immunotherapy. Surgical interventions could include either open, laparoscopic, or robotic-assisted surgery, depending on the patient’s overall health, the stage of the disease, and other considerations.

Open surgery for removal of prostate to manage localised prostate cancer was considered the gold standard since the inception of open retropubic radical prostatectomy for treatment in 1947. However, the technique was associated with a higher degree of morbidity and potentially longer recovery time. With the introduction & adoption of laparoscopic surgeries in the 1980s, the first laparoscopic radical prostatectomy (LRP) was undertaken in 1992. The primary limitation of LRP was the challenge of limited manoeuvrability in the pelvis. After its introduction to urology almost two decades ago, robotic surgery has offered a new avenue for the management of urological malignancies. Recent studies have also suggested that minimally invasive procedures such as robotic-assisted surgery provide encouraging oncologic outcomes mirroring those reported for open surgery. The effectiveness of this surgical tool increased its acceptance across the fraternity and has seen the establishment of multiple robotic centres across the country along with the increased availability of trained robotic surgeons.

Some of the benefits of robot-assisted radical prostatectomy (RARP) over conventional retropubic radical prostatectomy (RRP) are well-documented in the literature. These reported benefits of Robotic Prostate surgery over an open approach include the reduced length of hospital stay, reduced blood loss, and lower intraoperative complications. In addition, due to a better understanding of the functional anatomy and improvement of surgical procedures, erectile function and urine continence have been known to have similar outcomes over time. Robotic systems are aided by a dual 3-chip camera view that delivers a magnified three-dimensional vision and improves depth perception to the surgeon. Further, Robotic instruments are equipped with “endo wrist” technology that permits fine, dexterous movements in multiple planes with a wide range of motion.

In summary, Robotic-assisted surgery is an established/emerging technology for a number of urologic procedures with an acceptable safety profile. During the past decade, the acceptance of robotic assistance has paved the way for urologists to explore the entire spectrum of reconstructive, complete removal-related urologic procedures and renal transplants. Over time, the impact of robotic systems and devices on complex surgeries in urology and beyond may continue to increase. Furthermore, by extending the human surgeons’ ability to plan and carry out surgical treatments less invasively, robotic surgical systems have the potential to help address the pressing need to improve the efficiency of the health care delivery ecosystem in India.

(The author is Vice President and General Manager, Intuitive India. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)

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