#americanboardofsurgery

[karimsarhane]

Benefits of Robot-Assisted Surgery

Karim Sarhane, MD

Surgical robots have transformed how surgeons deliver medical solutions. Robot-assisted surgery allows doctors to perform complex surgical procedures faster and with more precision and control than was previously possible with conventional surgical techniques. Today, many surgeons frequently use robot-assisted surgery for various medical procedures. Among others, robotic surgery is used by general surgeons, urologists, gynecologic surgeons, colorectal surgeons, and cardiothoracic surgeons. Also known as robotic surgery, robot-assisted surgery comes with numerous benefits for both the patient and the surgeon. Doctors, through robotic technology, make tiny incisions that allow complex surgical procedures. Surgical robots are computer-controlled, self-powered devices programmed to aid surgeons in the positioning and manipulation of surgical instruments. During the procedure, three to four tiny robotic arms are inserted through a small incision on the patient’s body. One robotic arm holds a small camera while two arms assume the role of a surgeon’s hands. A fourth arm may help move tissue out of the way. Through a small console, the physician controls the robotic arms with a standby surgical team nearby for any needed assistance during the procedure. Because the robot’s “hands” are very dexterous, surgeons can operate in very tight body spaces that they would normally find very challenging to access through open surgery. The robotic arm’s reach is also greater than that of a human hand. In addition, robotic arms can rotate and maneuver the small surgical instruments in tight spaces in ways human hands cannot. A sophisticated high-definition camera provides enlarged 3D views of the surgical area that a human eye couldn’t possibly generate. Robot-assisted surgery is a great option when the surgeon needs to access hard to reach parts of the body. The tiny surgical instruments help avoid the necessity of the large incisions made when using conventional surgical tools. Since robotic surgery involves the use of smaller instruments, it becomes much easier to navigate around healthy tissue or organs. This reduces the potential impact the surgery can have on the patient’s body, as less tissue is touched or damaged. It also contributes to less pain and a more comfortable recovery journey. Robotic surgery is considered minimally invasive, and compared to conventional surgery tends to have a shorter recovery period. However, because people are very different, the healing times will of course vary for the same procedure. Also, patients can save on the cost of hospital stays, since most robot-assisted surgeries can be performed on an outpatient basis, which also saves time. Because of the greater precision and smaller incisions, the chances of surgical site infection are also reduced. Smaller incisions may also mean less bleeding and swelling after surgery. This can translate to requiring less pain-relieving medication that is typically associated with conventional surgery. Compared to conventional surgery, incidences of a patient requiring a blood transfusion or experiencing major complications after robot-assisted surgery are generally much fewer. However, it’s important to point out that robot-assisted surgery may not be an option for every procedure or patient. The suitability of the procedure will depend on the particular medical case. Therefore, patients should talk with their healthcare providers about the benefits, risks, and how robot-assisted surgery compares with conventional open surgery and other minimally invasive surgery options.

[karimsarhane]

Advances in Thyroid Cancer Diagnosis and Treatment

Karim Sarhane, MD

Thyroid cancer affects endocrine glands that regulate crucial bodily processes via hormone production. Tumor growth in the neck region, which characterizes thyroid cancer, can result in discomfort, difficulty swallowing, and inflamed lymph nodes. Previously, radiation was the go-to treatment option. However, recent advancements have enabled the medical community to understand the disease better, leading to more advanced diagnoses and treatments. Overdiagnosis, which refers to detecting small, slow-growing nodules or tumors that may not be cancerous, is а significant issue when diagnosing thyroid cancer. Studies from the National Cancer Institute (NCI) reveal that in one-third of instances where а questionable nodule (tumor) is removed from the thyroid, it is not cancerous. Researchers backed by the NCI have devised novel genomic tests to identify if these dubious nodules are cancerous, reducing unwarranted surgeries and enabling the selection of the most suitable treatment alternatives. Optical diagnostic imaging (OI) is a new technology that utilizes light to observe cellular, tissue, or organ structure and function, assisting in diagnosis. Compared to traditional imaging methods like x-ray, OI provides molecular specificity, flexibility, and safety, potentially mitigating issues of overdiagnosis and enhancing diagnostic efficacy. Additionally, it supports precise and non-invasive treatments for thyroid cancer. Fluorescence imaging (FI) is another promising modality for cancer diagnosis. It involves intravenous injection of a fluorescent dye before the operation. Upon exposure to а specific light wavelength, the dye emits fluorescence that helps highlight the parathyroid glands and other cancerous tissues. This technique offers several advantages over conventional imaging methods, including reduced invasiveness, cost-effectiveness, and superior spatial and temporal resolution. FI has demonstrated clinical potential in various applications, such as image-guided surgery. Doctors typically recommend radioactive iodine therapy (RIT) to treat differentiated thyroid cancers, such as papillary cancer originating from follicular cells in thyroid glands. RIT involves the patient taking a pill or liquid containing high doses of radioactive iodine, which collects in the thyroid gland and targets cancerous cells. Before treatment, doctors may conduct tests to determine if the cancer will likely respond to RIT. Targeted therapy is another thyroid cancer treatment involving drugs that specifically attack certain targets on cancer cells. Kinase inhibitors and anti-angiogenesis drugs are examples of drugs used in targeted therapy. Kinase inhibitors help treat thyroid cancer cells with mutations in specific genes, while anti-angiogenesis drugs disrupt the formation of new blood vessels supplying tumors with nutrients and enabling them to grow. An alternative treatment for thyroid cancer is ethanol ablation, whereby a doctor injects alcohol into the targeted nodule to shrink or kill tumor cells by changing the structure of their proteins. The procedure involves inserting a thin needle, guided by ultrasound, into the nodule to inject alcohol. It is one of the safest therapeutic profiles and has successfully been used to treat toxic and benign cystic nodules. Alcohol ablation is a good alternative for patients unwilling or unable to undergo surgery. RNA therapy is another innovative approach to treating thyroid cancer. It involves using small interfering RNA (siRNA) to target and silence genes associated with cancer cells. Anaplastic thyroid cancer (ATC), a difficult-to-treat form of thyroid cancer, can now be targeted with novel nanotechnology that allows for the precise delivery of RNA therapy to ATC cells. Animal testing has demonstrated RNA therapy's effectiveness in halting tumor growth and preventing cancer from spreading to other body parts.