Applications and Advances in Robotic-Assisted Oncological Surgery: Ready to Dock the 'Bot.

In the field of surgical oncology, the robotic surgical system is a tool that allows the surgeon to perform laparoscopic or thoracoscopic procedures by enhancing the skills of the surgeon. Thus, the robotic system provides the surgeon with magnified, 3-dimensional (3D) visualization and wristed instruments that the surgeon can remotely control. Compared with 2D visualization in conventional laparoscopic and thoracoscopic surgery, this 3D visualization heightens the depth perception of the surgeon. In addition, the wristed instrumentation enables the surgeon to precisely dissect structures — in particular, vascular structures and other deep and confined spaces, such as those of the pelvis, retroperitoneum, and mediastinum — compared with the “chopstick”-like instruments of conventional laparoscopic and thoracoscopic surgical procedures. The robotic surgical system’s computer also scales down the large radius of movements and eliminates tremors from the surgeon’s hands. In addition, during robotic-assisted surgery, the surgeon is sitting rather than standing and controls the movements of the robotic arm with his or her hands, with the fingers and wrists adding a very important ergonomic advantage that reduces surgeon fatigue. Surgical specialties continue to evolve with new and improved techniques and the application of novel technologies, as has been true of surgical techniques improved upon by applying robotics in the surgical oncology specialties. “Robotic surgery” is a misnomer. Procedures assisted by robotic technology are the same as traditional laparoscopic (or thoracoscopic) surgery or minimally invasive operations in that they are still performed by a surgeon who is operating a robot. Thus, the appropriate term is robotic-assisted laparoscopic (or thoracoscopic) surgery. Although robotic-assisted surgery is now widely available in the United States, the application of robotic technology in surgery became a reality 20 years ago. The robotic surgical system was first applied in surgical oncology in the setting of laparoscopic radical prostatectomy; robotic-assisted laparoscopic radical prostatectomy was initially performed in Europe in the early 2000s and then rapidly expanded into the United States.1,2 Use of the robotic surgical system was then extended to other types of surgical oncology in the fields of gynecological surgery, thoracic surgery, and general surgical oncology.2-4 More recently, techniques in transoral robotic-assisted surgery and robotic-assisted neurosurgery are being developed.5 In this issue of Cancer Control, several authors report on both well-established and developing applications of robotics in surgical oncology. The first article is authored by Dr Agarwal and colleagues, who review the technique and outcomes of robotic-assisted prostatectomy. Twenty years after the first robotic-assisted prostatectomy was performed, techniques continue to improve, leading to better oncological control and patient quality of life. Dr Emtage and others review techniques for robotic-assisted oncological kidney surgery. They report that morbidity and patient satisfaction rates are potentially improved with robotic-assisted renal surgery compared with traditional open and conventional laparoscopic renal surgery without compromising oncological control, particularly for nephron-sparing partial nephrectomies. Dr Luchey and coauthors discuss the evolving techniques and early outcomes with robotic-assisted cystectomy. Although the procedure is not widely performed, increasing numbers of centers around the world are applying robotic-assisted surgery for the management of bladder cancer. Drs Bush and Apte review techniques and outcomes with robotic-assisted surgery in gynecological oncology. They report that robotic-assisted surgery has resulted in the increased use of minimally invasive surgical procedures for endometrial cancer and in decreased complication rates in patients who are obese. Dr Velez-Cubian and colleagues review the benefits of adding a robotic surgical system to videothoracoscopic pulmonary resections. They report that robotic-assisted videothoracoscopic pulmonary lobectomy is as safe as conventional videothoracoscopic lobectomy, and that the robotic-assisted procedure resulted in decreased perioperative complications and shorter lengths of hospital stay than traditional open lobectomy. Mediastinal lymph node dissection and the early detection of occult mediastinal lymph node metastatic disease were also improved when using robotic-assisted videothoracoscopic approaches compared with conventional approaches to videothoracoscopy or Editorial