Surgical Options for Cancer Treatment in the UAE

1. Laparoscopic Surgery

Laparoscopic surgery involves the use of a laparoscope—a long, thin tube equipped with high-intensity light and a high-resolution camera at the front. The camera transmits images to a monitor, allowing the surgeon to see inside the patient’s body in real time.

Laparoscopic Surgery Procedure

1. Incisions: Small incisions, typically 0.5-1 cm in size, are made in the abdominal or pelvic region at strategic locations.

2. Insertion of Trocar: A trocar, a specialized surgical instrument, is carefully inserted through each incision. Trocars serve as entry ports for the laparoscope and other surgical instruments.

3. Gas Insufflation: Carbon dioxide gas is gently pumped into the abdominal cavity through one of the trocars. This insufflation process creates a working space by lifting the abdominal wall away from the organs. It also improves visibility by reducing tissue obstruction.

4. Laparoscope and Instruments: The laparoscope, a thin tube with a high-resolution camera and light source, is inserted through one of the trocars. The camera transmits real-time images of the internal organs and the surgical field to a monitor, allowing the surgical team to visualize the procedure in detail. Additional surgical instruments, such as graspers, scissors, or electrocautery devices, are inserted through the remaining trocars. These instruments are manipulated by the surgeon to perform the necessary procedures.

5. Tumor Removal: Using the laparoscopic instruments, the surgeon carefully manipulates and removes the tumour. The camera on the laparoscope provides a magnified and illuminated view of the operative site, aiding in precision and ensuring that surrounding healthy tissues are preserved.

6. Closure: After completing the tumour removal and any additional procedures, the surgical instruments are withdrawn, and the trocars are removed. Depending on the number and size of incisions, they may be closed with sutures or covered with small adhesive bandages.

7. Postoperative Care: Patients are monitored closely in the recovery area to ensure stable vital signs and to manage any immediate postoperative discomfort. Recovery typically involves minimal scarring, reduced pain, and shorter hospital stays compared to traditional open surgery.

Applications:

• Colorectal Cancer: Laparoscopic surgery is frequently used for the resection of colorectal tumours. It allows for precise removal of the affected colon or rectal segments with minimal damage to surrounding tissues.
• Gastric Cancer: This technique is employed for partial or total gastrectomies, where part or all of the stomach is removed.
• Gynecologic Cancers: Commonly used for the treatment of ovarian, uterine, and cervical cancers. It enables the removal of tumours while preserving reproductive organs when possible.

2. Robotic-Assisted Surgery

 Robotic-assisted surgery leverages advanced robotic systems to enhance the precision, flexibility, and control of surgical procedures. The surgeon operates the robotic system from a console, using controls to manoeuvre the robotic arms equipped with surgical instruments.

Robotic-Assisted Surgery Procedure

1. Setup: Similar to laparoscopic surgery, small incisions (typically 0.5-1 cm) are made in the abdominal or pelvic region at strategic locations. Trocars, specialized surgical ports, are inserted through these incisions to provide access to the surgical site.

2. Robotic System Docking: Robotic arms, each equipped with different surgical instruments including cameras, scalpels, and forceps, are docked to the trocars. The robotic system is calibrated to ensure precise alignment and functionality during the procedure.

3. Surgeon Control: The surgeon sits at a console located away from the operating table, typically in the same operating room but separated from the patient. The console provides a 3D high-definition view of the surgical site, enhanced with magnification and clarity beyond what is visible to the naked eye.

4. Instrument Manipulation: Using hand controllers and foot pedals at the console, the surgeon manoeuvres and controls the robotic instruments. The surgeon's hand movements are translated into precise movements of the robotic instruments inside the patient's body. The robotic system filters out hand tremors, allowing for steady and accurate actions even during delicate manoeuvres.

5. Tumor Removal: The robotic arms offer enhanced flexibility, rotation, and articulation capabilities that exceed human dexterity. This enables precise manipulation and removal of tumours located in challenging or hard-to-reach areas within the abdominal or pelvic cavities. The high-definition cameras provide detailed visualization, ensuring that the surgeon can accurately identify and safely remove the tumour while minimizing damage to surrounding healthy tissue.

6. Closure: After completing the surgical procedure, the robotic instruments are carefully withdrawn from the patient's body. The small incisions used for trocars may be closed with sutures or covered with adhesive bandages, depending on the surgeon's preference and the size of the incisions.

7. Postoperative Care: Patients are monitored closely in the recovery area to assess their condition and manage any postoperative discomfort. Robotic-assisted surgery often leads to shorter hospital stays, reduced pain, and quicker recovery times compared to traditional open surgery methods.

Applications:

• Prostate Cancer: Robotic-assisted prostatectomies are commonly used, offering enhanced precision in removing the prostate gland while sparing surrounding nerves and tissues.
• Kidney Cancer: This technique is used for partial or radical nephrectomies, allowing for the precise removal of cancerous tissues while preserving kidney function.
• Gynecologic Cancers: Used for hysterectomies, oophorectomies, and other complex procedures, it enhances the surgeon’s ability to perform delicate operations with precision.

Minimally Invasive Surgery (MIS), encompassing laparoscopic and robotic-assisted techniques, offers substantial advantages in cancer treatment. These advanced surgical options, widely available in leading hospitals across the UAE, enhance the precision and effectiveness of cancer surgeries while minimizing patient discomfort and recovery time. As technology continues to evolve, MIS will likely play an even more critical role in the comprehensive care and treatment of cancer patients.

2. Open Surgery

Cryosurgery involves the application of extremely cold temperatures to freeze and destroy abnormal tissues, including cancerous cells. Liquid nitrogen or argon gas is commonly used as the freezing agent, creating ice crystals within the cancer cells and leading to their destruction.

Cryosurgery Procedure:

1. Preparation: The patient is typically given local or general anaesthesia, depending on the location and size of the tumour.

2. Guidance: Imaging techniques such as ultrasound, MRI, or CT scan may be used to guide the placement of cryoprobes (thin, hollow needles) directly into the tumour.

3. Freezing Process: Liquid nitrogen or argon gas is circulated through the cryoprobes, causing the temperature around the probes to drop significantly.

4. Ice Formation: As the temperature drops, ice forms both inside and around the cancer cells, leading to cellular destruction through mechanisms like direct ice crystal formation and disruption of cell membranes.

5. Thawing Cycle: The frozen tissue is allowed to thaw, and the process may be repeated to ensure thorough destruction of the tumour.

6. Monitoring: The procedure is monitored closely using imaging techniques to ensure accurate targeting and complete treatment of the cancerous tissue.

Applications:

• Prostate Cancer: Cryosurgery is often used as an alternative treatment for localized prostate cancer, particularly for patients who cannot undergo traditional surgery or radiation therapy.
• Liver Cancer: It is used for small liver tumours that are not amenable to surgical resection or other treatments. Cryosurgery can effectively target and destroy these tumours while preserving more healthy liver tissue.
• Skin Cancer: Basal cell carcinomas and certain types of superficial skin cancers can be treated with cryosurgery, offering a non-surgical option with minimal scarring.

Cryosurgery represents a valuable option in the armamentarium of cancer treatment, particularly for tumours that are difficult to treat using traditional surgery or radiation therapy. In the UAE, this technique is utilized in leading healthcare facilities to provide patients with effective, minimally invasive treatment options tailored to their specific cancer diagnoses.