On January 19, 2024, a middle-aged woman was discharged a day after a crucial surgery that gave her a new lease of life. Dr Raj Nagarkar, managing director and chief of surgical oncology and robotic services, HCG Manavata Cancer Centre (HCGMCC) & Hospitals, Nashik, who conducted the robotic surgery, was immensely satisfied with how it turned out. He recalls that the lady, Amina (name changed), initially visited her gynecologist for heavy menstrual bleeding and irregular menstrual cycles, which had been occurring since mid-2023. Besides, there were comorbidities — diabetes, obesity and hypothyroidism. She also weighed over 100 kg while her height was less than 5 ft. To add to the complication, ultrasounds showed cancerous growth in her left kidney, which was further confirmed by a biopsy. He shares that Amina then reached out to him, and an MRI was the first step in diagnosing her condition. “Her symptoms pointed to uterine fibroids, but the diagnosis of kidney cancer was incidental,” recalls Dr Nagarkar.
Following her diagnosis, Dr Nagarkar performed a natural orifice transluminal endoscopic surgery (NOTES) on the 18th of January 2024.
What is NOTES?
Dr Nagarkar leveraged robotic technology to perform a natural orifice transluminal endoscopic surgery. Her surgery comprised a nephrectomy (surgical kidney removal) and a hysterectomy in a single operation. The procedure enabled him to remove the left kidney and uterus through tiny incisions made in the abdomen and vagina. He explains that during this robotic surgery, doctors make use of a 3D image that can be magnified up to 10 times. “This helps surgeons to operate on the cancer with precision, resulting in minimal blood loss and reduced collateral damage to tissues, eliminating chances of infection,” says Dr Nagarkar. “The entire procedure is to make the surgery safer and more comfortable,” he explains.
Dr Nagarkar also explains that the only post-surgical restriction on patients is that they cannot sit on the floor or squat for at least 15 days after the procedure.
How effective is robotic surgery?
Dr Nagarkar shares that depending on the case, doctors may choose to operate on the organs in separate sittings; however, he opted to use the robot-assisted platform, with benefits such as precision and minimized surgical trauma.
He adds that certain misconceptions exist about minimally invasive surgery or using robots for surgery, including the belief that doctors compromise the quality of the procedure. To clear the air, he explains, “Advancements in robotics make the procedures extremely effective — the success rate is over 95%. The robotic NOTES procedure offers consistent, reliable results with decreased blood loss and pain as well as reduced recovery time.”
Transformative outcome of the robotic surgery
Dr Nagarkar highlights that removing the uterus and a kidney in the same sitting using the conventional procedure is avoided as it poses the risk of infection or developing a hernia or blood clots in the limbs or pelvis, especially for older people. “Besides, the person would need to be hospitalized for a week, followed by rest and the usage of an abdominal belt for three months,” he adds.
On the other hand, the NOTES procedure has manifold benefits, he tells Happiest Health. With both organs being removed in one sitting, the risks of bleeding and infection are reduced. Talking of the case, he says, “Amina experienced minimal scarring — just five small incisions of 5–10 mm on her abdomen. She was able to walk within six hours of the surgery and resumed food consumption the next day. She was even discharged on the third day without requiring significant pain management.”
The outcome of this surgery highlights the transformative potential of the robotic NOTES procedure in addressing complex medical conditions, particularly in those with comorbidities like obesity.
