This article discusses the potential advantages and disadvantages of the minimal access approach in cancer surgery.

In a previous post, we talked about what a minimally invasive (or minimal access) surgery is, and how it is different from conventional surgery for cancer.

It is worth reiterating at this point that the primary goal of any curative cancer surgery is the complete removal of cancer (oncological clearance).  The minimal access approach can only be considered provided there is no compromise of this fundamental principle of oncological clearance.

The advantages of a minimal access approach are:

1. Less post-operative pain (especially for a laparoscopic or thoracoscopic procedure)
2. Quicker recovery from surgery
3. Shorter hospital stay
4. Smaller surgical incisions and hence better cosmesis
5. Magnified vision during surgery
6. Less blood loss

The disadvantages are:

1. More surgical training and expertise required
2. Dependence on specialized equipment and instruments
3. It may be unsuitable for certain patients and for certain cancers
4. Longer operating time
5. Higher cost (which may be offset by a reduced hospital stay and quicker recovery)
6. Technical challenges for the surgeon
   • Need to use instruments from a distance (similar to using chopsticks instead of hands)
   • limited dexterity of instruments as compared to surgeon’s fingers
   • limited haptic feedback (inability to “feel” body tissues)
   • 2-D vision on screen vis-à-vis 3-D perception in conventional surgery

Some of these technical drawbacks are being overcome with improvement in technology including the development of surgical robots.

To summarize, minimal access surgery is a useful tool in the armamentarium of a surgical oncologist.  For best outcomes, it must be utilized after weighing all the pros and cons for each individual patient.