History of Minimally Invasive Surgery in Cancer

Large incisions were traditionally used for carrying out radical resections as the emphasis was on removal of the cancer and possible cure. A paradigm shift has occurred over a period of several decades now with technological advances enabling radical resections using smaller incisions that reduce the morbidity of radical open surgery while remaining oncologically safe. Introduction of minimally invasive surgery (MIS) has brought about a phenomenal change in the way surgery is performed by the surgeon. Although first developed for benign diseases, MIS has rapidly evolved in cancer surgery. It is associated with lower blood loss, smaller scar, shorter length of hospital stay (LOS) and improved overall quality of life (QOL) in most instances. MIS not only has a role in the diagnosis and staging of cancers but is also widely used for radical resections, most notably of esophageal, gastric, colon, and prostate cancer as well as for various palliative procedures. The introduction of robotics has further refined MIS, the benefit lies in crisp precision and 7° of freedom configuration, which enhances surgeon’s dexterity and aids in performing complex surgeries even in a narrow pelvis. This chapter gives an outline of the evolution of MIS in cancer and its present status across some common cancers.