Overview 

Previously, cancer surgery was often associated with large incisions, long hospital admissions and extended periods of recovery. However, now with the advancement of medical technology and surgical techniques, many patients are offered an alternative: minimally invasive cancer surgery. This is a new emergent type of surgery that removes cancerous tissue with smaller incisions using the help of imaging devices, such as a laparoscope (a special camera which is inserted into the abdomen to assist surgeons when operating to examine this region of the body), amongst other options.^1,2,3 This article explains what minimally invasive cancer surgery is, how it works, the main techniques used, and who may be a good candidate. It also explores the benefits of the surgery and the exciting promise of this field.

What is minimally invasive cancer surgery?

Minimally invasive cancer surgery is a group of associated surgical techniques performed on patients by surgeons using several small incisions (often called ports) guided by surgical cameras and monitors, resulting in less patient trauma and a quicker recovery.^1,2,3 A flexible tube with a camera or light, known as an endoscope, may be used by surgeons to look inside the body to find where the tumour is through small incision sites. Alternatively, a laparoscope (a small camera specifically inserted through the abdominal wall to observe tissues and organs in the region) can be used to guide the surgeon by transmitting images to a video monitor.³ This allows the surgeon to operate with precision inside the body without needing to fully open the area where the tumour is found (open surgery).

Techniques used in minimally invasive cancer surgery

As aforementioned, there are several techniques together which are referred to as minimally invasive cancer surgery. The most common surgical interventions are:

Laparoscopic surgery 

This surgical procedure involves a surgeon making small incisions across the abdomen, allowing a laparoscope to be inserted into the incision, providing a magnified view of the abdominal region. Following this, the surgeon can begin to operate using surgical instruments through another incision made, using the monitor as a guide for where to operate. After removal of the cancer and an examination of the remaining area, the surgeon will close up the small sites of incision. Usually, this procedure is faster than open traditional cancer surgeries, taking from 30 minutes to 3 hours to complete.^3.4

This technique is widely used for cancers of the:^5,6,7

• Adrenal glands
• Colon (large intestine)
• Liver
• Pancreas
• Reproductive organs
• Stomach

Thoracoscopic surgery (video-assisted thoracic surgery, or VATS)

This type of surgical procedure is normally used for cancers of the lung or oesophagus. This approach replaces traditional open chest surgery (thoracotomy), where a large incision is made across the chest, opening the ribs apart to surgically remove lung or oesophageal cancers. Similar to other minimally invasive cancer surgeries, small incisions are made to allow surgical instruments and a camera (usually a thorascope) to provide the surgeon a view of the surgical area and the ability to perform safe excision of the cancer. 

Minimally invasive techniques, using camera and monitor assistance to remove lung cancers, have now been shown to be superior to traditional open surgical techniques in the UK-led VIOLET trial.⁹

Robotic-assisted surgery

Robotic systems, such as the da Vinci Surgical System, have become increasingly used in minimally invasive cancer surgery in recent years. This involves surgeons using a console to guide robotic arms with instruments to perform minimally invasive surgeries. The console translates the surgeon's hand movements into precise micro movements, navigating the formation of ports on the body and cancer removal.10 This technique provides excellent visibility, flexibility, and precision, especially in narrow spaces such as the pelvis for prostate or gynaecological cancers, where surgeons previously had restricted access in fully removing References should be after the Full stop tumours.^11,12

The progression of medical advancements now means that the use of robotic-assisted surgeries is increasingly being expanded to other minimally invasive cancer procedures like colorectal and thoracic surgery.

Benefits of minimally invasive cancer surgery

Minimally invasive approaches have revolutionised the experience of cancer surgery for many patients. One of the main reasons minimally invasive cancer surgery has become a more popular option recommended by doctors and surgeons is that it offers a number of important advantages over traditional open surgery.¹³ Although each patient's experience is different, many report significant gains in their comfort, recuperation, and overall treatment satisfaction. 

The benefits include:³

1. Smaller incisions: Instead of one large cut to enter and operate on the tumour site, minimally invasive surgeries use several small cuts, measuring roughly up to an inch or less per cut. This means patients will have less visible scarring and have better body positivity and self-esteem post-surgery. For cancers in areas like the abdomen or chest, this can make a significant difference compared to the large scars left by open surgery
2. Reduced pain and discomfort: As a result of the smaller incisions, there is less disruption to surrounding tissues and organs for patients who undergo minimally invasive cancer surgery. It has been highlighted that cancer patients experience less pain during recovery using this type of surgery. The majority of patients also require fewer strong pain medications, which will make recovery from surgery a more comfortable experience. Additionally, it also lowers the risk of post-surgical complications and side effects from pain medication
3. Faster recovery and shorter post-surgery hospital stays: Cancer patients who undergo minimally invasive surgery often spend significantly less time in the hospital. In some instances, patients may be treated as day surgery cases. This means that if they follow their doctor’s advice, they may be discharged the evening of the surgery, depending on whether their doctor is satisfied with their outcome and response. Most patients are able to leave the hospital between 2-7 days following surgery. As healing is faster, people are able to return to normal daily activities, work, and family responsibilities sooner. Thus, allowing cancer patients to feel more like themselves again provides a valuable boost to emotional well-being at a difficult time
4. Lower Risk of Complications: All surgeries carry a degree of risk; however, minimally invasive surgeries are associated with lower rates of medical complications. Smaller incisions reduce the chance of wound infections and excessive bleeding. There is also less strain on the body overall, which is particularly important for older patients or those with multiple health conditions
5. Improved precision and Accuracy: As surgeons who conduct minimally invasive surgeries often use cameras with magnified high-definition cameras, this allows for greater accuracy of surgical procedures as they have a better view of organs, blood vessels, and tissues in great detail. Furthermore, robotic-assisted surgeries allow for extremely precise movements that may not be possible with the human hand alone. This can be particularly valuable in delicate surgeries, such as those for prostate or gynecologic cancers. Consequently, these surgeries are more likely to be safer and precise than traditional open cancer surgery

Who is a candidate for minimally invasive cancer surgery?

The decision depends on several factors, including:

• The type and stage of cancer
• The size and location of the tumour
• The patient’s overall health and medical history
• The expertise and equipment available at the hospital

Typically, minimally invasive surgical techniques are often used for early-stage and non-advanced cancer patients with few radiation treatments or prior surgeries. Many surgeons still prefer to perform open surgeries on patients with:

• Advanced cancer 
• A tumour that has spread extensively (Metastasis)
• Patients with a high Body Mass Index (BMI) or obesity
• Complicated medical history 

Summary 

Minimally invasive cancer surgery is a modern approach that has been replacing conventional open surgery worldwide. This approach uses small incisions, cameras and surgical instruments to remove solid tumours in cancer patients. This method often results in less pain, smaller scars, quicker recovery and fewer complications for patients. Common minimally invasive surgical techniques used in cancer surgery includes: laparoscopic surgery (small incisions to the abdomen to create access for surgeons to remove tumours in this region guided through a laparoscope and monitor), thoracoscopic surgery (also known as Video-Assisted Thoracic Surgery, or VATS) where small incisions are made to allow surgical instruments and a thorascope camera to excise tumours in the chest and oesophagus. Also, robotic-assisted surgeries are a type of minimally invasive cancer surgery. This is where a surgeon navigates a console controlling robotic arms to navigate hard-to-reach areas where tumours reside, such as the pelvis, to remove the tumour. Although minimally invasive techniques are not appropriate for all patients or cancers, many patients benefit from less pain and complications, quicker recovery and shorter hospital stays. Moreover, patients also develop better body positivity and self-esteem as they have less visible scarring due to the smaller incisions, as well as a boosted quality of life.

Minimally invasive surgery is expected to become progressively more important and widespread in cancer treatment as it has exhibited improvements in the safety, accuracy, and efficiency of cancer therapy with patients at the centre.