This article describes what a minimally invasive surgery (also known as minimal access or key-hole surgery) is, and how it is different from conventional surgery for cancer.
Minimally invasive surgery is performed using special equipment via one or more small incisions instead of a large incision. Because the incisions are smaller and there is less retraction (pulling apart the incision during surgery for exposure), post-operative pain is reduced, recovery from surgery is faster, and the cosmetic outcome is superior. Usually, this approach is used for surgeries in body cavities – abdomen (laparoscopy), chest (thoracoscopy), or joints (arthroscopy). More recently, this method is also being applied to surgeries in non-cavity areas of the body (e.g. neck, groin, breast) where a cavity is created by inserting gas into tissue spaces. Minimally invasive surgeries can also be performed using a robotic surgical system (robotic surgery).
“Big surgeons make big incisions” was a common surgical quote used during my surgical residency days. In the late 90s and early years of this century, minimal access surgery became more established for relatively straightforward surgeries like removal of the gall bladder or the appendix. For cancer surgery, however, the minimally invasive approach was not adopted until much later. This delay was partly due to the difficulty of performing complex procedures using minimal access techniques, and partly due to the fear of compromising oncologic principles.
With advances in surgical technology as well as extensive minimal access training, surgeons were able to perform more and more complex procedures using minimally invasive techniques. Simultaneously, large-scale and high-quality trials also showed that minimal access surgery in select patients, for select cancers, performed by well-trained surgeons did not compromise on the cancer clearance or recurrence rates. Today, cancer surgery is increasingly being done by a minimal approach in well-selected patients.
Despite the potential advantages of a minimally invasive approach, it is important to keep in mind that the actual cancer surgery and its principles do not change. The entire cancer and all tissues which could harbor potential cancer have to be removed without fail. A minimal access approach should only be considered when this oncologic standard of care can be maintained. The feasibility, as well as the benefits vs risks, can only be evaluated on an individual patient basis, after assessing patient factors, disease factors, and institutional expertise.
A subsequent post goes into more detail about the pros and cons of the minimally invasive approach in surgical oncology.