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Tratamento robótico do cancro do reto
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O cancro do reto é o quinto cancro mais frequente em Portugal, com 4447 novos casos diagnosticados em 2018, correspondendo a 9.1% de todos os cancros diagnosticados no nosso país. Representa 1164 mortes por ano, correspondendo a 4,0% das mortes por doenças neoplásicas.
Assim sendo temos de criar estratégias de diagnóstico e terapêutica eficazes que permitam diagnosticar precocemente, reduzir as taxas de mortalidade e aumentar a sobrevida dos doentes, com preservação da função orgânica e qualidade de vida.
A qualidade do tratamento cirúrgico e o efeito do cirurgião são importantes fatores prognósticos no cancro retal. A laparoscopia veio melhorar o impacto da cirurgia na parede abdominal com redução das incisões mutiladoras e das hérnias incisionais. A cirurgia robótica trouxe uma minúcia na dissecção incomparável e uma imagem “in your face” da profundidade da pélvis, permitindo ver e preservar todas as estruturas nervosas, melhorando os resultados funcionais.
O uso de robots remonta desde 400 aC, mas o grande avanço deu-se no fim dos anos 90, com a intervenção da NASA e com a criação do sistema da Vinci Surgical System da Intuitive Surgical®. Este sistema permite controlar através de uma consola com manípulos e pedais toda a cirurgia. O robot é composto por 2 a 4 braços articulados flexíveis, que permitem ter uma visualização a 360 graus e uma imagem tridimensional sem manipulação de imagem nem óculos 3D.
O seu uso foi amplamente difundido na área da urologia, mas as suas aplicações são cada vez mais diversas na área da cirurgia do cancro retal.
Apresenta diversas vantagens, no entanto, tem custos elevados. Esta dissertação pretende avaliar o uso desta técnica, a sua eficácia e rentabilidade para a implementação num futuro próximo.
The rectal cancer is the fifth most diagnosticated cancer in Portugal with 4447 cases in 2018, which corresponds to 9.1% of all cancers diagnosed. Represents 1164 deaths per year, with 4.0% of mortality due to neoplastic diseases. Therefore, it must be created effective diagnostic and therapeutic strategies, to allow an early diagnose and reduction of mortality rates and increase patient overall survival, with preservation of organ function and quality of life. The most important prognostic factor of rectal cancer is the quality of the surgical treatment and the expertise of the surgeon. Laparoscopy surgeries decreased the impact on the abdominal wall by reducing mutilating incisions and less incisional hernias. The robotic surgery brought an unparalleled detail to the dissection and an “in your face” image in depth of the pelvis, allowing to see and preserve all the nervous structures, improving functional outcomes. The use of robot’s dates back to 400 BC but the big breakthrough came in the late 90s, with the intervention of NASA and the creation of the da Vinci Surgical System by Intuitive Surgical®. This system allows to control the entire surgery using a console, with handles and pedals. Robot is composed by 2 to 4 flexible articulated arms, which allow a 360-degree view and a three-dimensional image and not just “induced” by image manipulation and 3D glasses. Its use has been widespread in the area of urology, but its applications are increasingly diverse in the area of rectal cancer surgery. Despite the advantages, costs are high. This dissertation intends to evaluate and compare the use of this technique, allowing us to evaluate its effectiveness and profitability, so we can implement this new technique for the near future.
The rectal cancer is the fifth most diagnosticated cancer in Portugal with 4447 cases in 2018, which corresponds to 9.1% of all cancers diagnosed. Represents 1164 deaths per year, with 4.0% of mortality due to neoplastic diseases. Therefore, it must be created effective diagnostic and therapeutic strategies, to allow an early diagnose and reduction of mortality rates and increase patient overall survival, with preservation of organ function and quality of life. The most important prognostic factor of rectal cancer is the quality of the surgical treatment and the expertise of the surgeon. Laparoscopy surgeries decreased the impact on the abdominal wall by reducing mutilating incisions and less incisional hernias. The robotic surgery brought an unparalleled detail to the dissection and an “in your face” image in depth of the pelvis, allowing to see and preserve all the nervous structures, improving functional outcomes. The use of robot’s dates back to 400 BC but the big breakthrough came in the late 90s, with the intervention of NASA and the creation of the da Vinci Surgical System by Intuitive Surgical®. This system allows to control the entire surgery using a console, with handles and pedals. Robot is composed by 2 to 4 flexible articulated arms, which allow a 360-degree view and a three-dimensional image and not just “induced” by image manipulation and 3D glasses. Its use has been widespread in the area of urology, but its applications are increasingly diverse in the area of rectal cancer surgery. Despite the advantages, costs are high. This dissertation intends to evaluate and compare the use of this technique, allowing us to evaluate its effectiveness and profitability, so we can implement this new technique for the near future.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Tratamento robótico Cancro do reto