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Quicker, Scarless Approach To Stomach Tumors

Tue, 07/05/2011 - 6:46am

According to surgeons in India, patients with gastric tumors in their stomach do not have to suffer an eight-hour long surgery, but instead can opt for a procedure that lasts a matter of minutes and doesn't require hospitalisation. This new procedure – the world's first flexible endoscopy robotic surgery in the stomach – was successfully performed on a total of three patients, one patient per day from July 1 to 3.

A flexible endoscope with small robotic arms was inserted through the patient's mouth to the stomach, while the surgeon monitored it on a computer screen. Using joystick and buttons to control the robotic arms, the surgeon then removed the cancerous tumour and the patient went home after the operation. The technology was developed by Associate Professor Louis Phee, Head of the Division of Mechatronics and Design, School of Mechanical and Aerospace at Nanyang Technological University and Professor Ho Khek Yu Lawrence, Senior Consultant at the Department of Gastroenterology and Hepatology, National University Hospital, after six years of research. This system, named MASTER (Master And Slave Transluminal Endoscopic Robot) was entirely designed and built from scratch in NTU.

Current robotic keyhole surgeries still require a small cut at the stomach to enable a rigid robotic endoscope to enter and do the surgery. This new flexible robotic endoscope enters through the mouth. By controlling an external console, the surgeon is able to make the robot perform intricate surgical procedures. For the surgeries done in India, the robot is used to perform Endoscopic Submucosal Dissection (ESD) - the removal of a tumour embedded in the stomach wall, without puncturing the stomach wall. Without this robotic system, a patient is likely to undergo open surgery to remove the tumor.

This procedure also opens up new surgical possibilities, as the robot is able to cut a small hole in the stomach wall to get access to other organs like the liver, kidney and pancreas to perform intricate surgery. After the surgery is done, it slides back into the stomach, mends the hole in the stomach wall and exits out of the mouth again. There may come a time when a patient goes for surgery and all he or she needs do is open their mouth.

Apart from speeding up the operation process and leaving no scars, this robotic procedure is also significantly cheaper than normal surgery. The robotic arms, which are up to six milimeters in diameter, have the capacity to "feel" how hard or soft the delicate tissues of the stomach and intestines are, so doctors at the console can vary the pressure accordingly. The combined diameter of both arms is up to 16 mm.

To carry out the experiments on the device's effectiveness and efficiency, a multi-centef experiment was decided as collaborators from Hong Kong and Germany have shown keen interests. Since the Asian Institute of Gastroenterology (AIG) was the first to get the relevant approvals for human trials and patients were easily available there, they were the first to carry out the operation. The future plan will be to expand trials to other centers in Hong Kong and Germany. While relevant approvals have already been given to proceed with human trials in Singapore, patients with this particular ailment are rare and not easily found in the country.

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