Dr. Ashish Goel – Best surgeon for Robot Assisted Laparoscopic Colorectal Cancer Surgery in North Delhi
Dr. Ashish Goel has 25 years experience in oncology and oncosurgery. He is the best cancer surgeon and oncologist in Delhi, NCR. He has a keen interest in Breast Oncology, Head and Neck Surgery and Thoracic Oncology. He is equally trained in treating Gastrointestinal, Genitourinary and Gynaecological cancers. Dr Goel is currently Director and Unit Head Surgical Oncology at Action Cancer Hospital, Delhi.
Laparoscopic colon resections are being performed with increasing frequency in the United States, though the use of minimally invasive techniques in colorectal surgery has lagged behind its application in other surgical fields. Since the first laparoscopic colectomy was described in 1991, a great deal of controversy has surrounded its use, particularly in the management of colorectal cancer. Several important new studies1–3 have demonstrated the benefits and safety of laparoscopic colorectal surgery, making it now the preferred approach in the surgical management of many colorectal diseases.
Are There Immune Benefits to Laparoscopic Surgery?
A consequence of those early concerns was an increasing interest in understanding the physiologic consequences of surgery, both open and laparoscopic, and its effects on tumor biology and immune function. It is well known that surgery leads to transient immunosuppression, though the underlying etiology remains unclear. A well-known cascade of physiologic and immunologic responses occurs after surgery. Inflammation involves the recruitment of macrophages and neutrophils at sites of tissue injury, release of proinflammatory cytokines and growth factors to promote wound healing (and that may also stimulate tumor growth), and activation of T cell (cellular) and B cell (humoral) immunity. Surgery has been shown to dampen each of these responses, leading to varying degrees of immunosuppression. Laparoscopic surgery, which is associated with less patient trauma through smaller incisions and less postoperative pain, may be associated with less immunosuppression, compared with open surgery, though the data remain a subject of debate and the clinical significance of this effect remains unclear.
How Is Laparoscopic Colectomy Done?
The technique of laparoscopic colectomy has a long learning curve because of the advanced laparoscopic skills it entails. Unlike other laparoscopic procedures, such as the Nissen fundoplication or cholecystectomy, colorectal procedures involve dissection and mobilization of intra-abdominal organs in multiple quadrants. Laparoscopic colorectal surgery involves the use of several small incisions through which a specialized camera and several laparoscopic instruments are inserted (Figures 1, ,2).2). An insufflator blows carbon dioxide (CO2) into the peritoneal cavity, creating a pneumoperitoneum that provides a working space to perform the operation. Tilting of the operating-room table in various positions during an operation uses gravity to allow intra-abdominal organs to fall away from the area of dissection, providing necessary exposure that would normally be achieved through the use of retractors. Intestinal resection requires laparoscopic ligation of large vessels, mobilization and removal of a long floppy segment of colon, and restoration of intestinal continuity. Once the colon segment has been completely mobilized and its blood supply divided, a small skin incision is made to exteriorize the colon, a resection and anastomosis are performed extracorporeally, and the rejoined colon is placed back into the abdomen.