Dr Sanjay Gogoi, HOD And Consultant-Urology, Manipal Dwarka Hospital talks about technology adoption in the management and treatment of prostate cancer in India
The birth of Urology as a surgical sub-speciality had humble origins. It started as an off-shoot of Surgical treatment of diseases of the Urinary system. In the beginning, there was not much to distinguish this branch from its parent. However, after the first endoscope was introduced in 1895 to peer into the urinary bladder, there was no stopping the use of technological innovations of the Urologists. Furthermore, after a little over a century, this field has become one of the most technologically-driven medical field.
Prostate cancer is the second most common cancer afflicting men. Despite having a plethora of modern diagnostic tests, prostate cancer was eluding early detection as no specific symptoms would raise clinical suspicion. Hence the majority of the cases are diagnosed at a late stage. This led to general acceptance of this condition as an inevitable adverse event in elderly men.
The tables were turned after a blood test called the Prostate Specific Antigen (PSA) was introduced and was shown to correlate with prostate cancer. As the world over, PSA screening became a norm, early detection and treatment of Prostate cancer became a reality. However, the surgical treatment – Radical Prostatectomy is a complex procedure to learn and fraught with serious complications. Only a handful of surgical teams worldwide could attain the trifecta of cancer control, urinary continence, and sexual potency preservation. This germinated the unfortunate bias in the mind of most urologists to treat this condition with castration after it was shown by Huggins and Hodges in 1941 to retard its growth. In India, as late as the late 1990s, just a handful of centres were carrying out Radical Prostatectomies.
The Robotic Radical Prostatectomy provides a number of advantages over traditional prostatectomy, including the potential for lesser blood loss and blood transfusions, as well as a shorter hospital stay. In my experience, Intuitive’s surgical robot (commercially available as da Vinci surgical system) provides better visualization and understanding of the pelvic anatomy because of its 3D view and the ability to magnify the visual ten times over. In addition, it gives an enhanced dexterity to work in the small pelvic space compared to laparoscopic surgery due to seven degrees of freedom. Due to the above advantages, preservation of urinary sphincter and sexual potency related nerve bundles while conducting radical prostate cancer surgery has become consistently attainable goals.
Due to its potential for increased precision, robotic surgery for prostate cancer is gaining favour. The entire prostate and pelvic lymph nodes are removed during the procedure through four small 8 mm cuts in the abdominal wall. With a significant number of robotic surgical systems now available worldwide and the snowballing interest from the surgeon community in India, it would not be an exaggeration to acknowledge the impact of this efficient surgical tool on the lives of thousands of patients who undergo robotic radical prostatectomy surgery annually.
The introduction of robotic surgery was a game-changer in the surgical approach to urological cancers, and most surgeons, particularly urologists, would agree that the benefits far outweigh the drawbacks. In addition, robotic technology has empowered laparoscopic urologists to perform minimally invasive surgery with greater ease enabling a more significant and faster adoption in the surgeon community. Therefore, facilities equipped with the latest in cutting-edge surgical technology and adept surgical care teams that provide patients with potentially improved outcomes tend to be favoured.
Robotic assistance in urology has only increased in recent years; having already transformed the operating room, this innovative approach still holds great potential for growth. As awareness grows and adoption increases, the new capabilities that the technology provides surgeons and the resulting clinical outcomes, will continue to have a lasting positive impact on the therapy area leading to a greater emphasis on training. Robotic surgery, in my opinion, will likely become the dominant way of all surgery and will help shape India’s future healthcare delivery.