Robotic-Assisted Colorectal Surgery

Robotic-Assisted Colorectal Surgery

The colon, also known as the large bowel, is a vital part of the body’s digestive system. The digestive system aids the body to remove and process nutrients (e.g. vitamins, minerals, carbohydrates, fats, proteins and water) from food and the elimination of waste material from the body. It is the first part of the large intestine and is about 5 feet long, while the last part of the large intestine consisting of the rectum and anal canal, is about 6 - 8 inches long. The anal canal ends at the anus, which is the opening of the large intestine to the outside of the body.

Colon cancer can start anywhere in the colon. For example, rectal cancer starts in the rectum, which is where the body stores stools until you have a bowel movement.

According to GLOBOCAN 2012 estimates, colorectal cancer is the second most common cancer in Malaysia for both males and females.

Robotic-Assisted Colorectal Surgery

Q:

Who are at risk?

A:

Malaysia is experiencing an aging population, with increasing affluence and an increased prevalence of colorectal cancer risk factors like a westernised diet, obesity, and smoking. Since about 80% colorectal cancer cases in Malaysia are diagnosed in individuals over 50 years old, this aging trend may contribute to a further increase in prevalence.

Q:

Q: What are the signs and symptoms?

A:
  • Blood in the stool or black stools
  • A change in bowel habits without reason (e.g. persistent constipation, diarrhea)
  • Unexplained weight loss
  • Abdominal discomfort (e.g. cramps, gas or pain)
  • Feeling of incomplete bowel emptying
  • Vomit
  • Symptoms of anemia, such as cold hands and feet, fatigue, rapid heartbeat, pale face, shortness of breath and dizziness

Q:

What is colon cancer staging and how is it related to survival rate?

A:

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, i.e. their chance of recovery.

Robotic-Assisted Colorectal Surgery
Stage 0 Cancer has not grown beyond the inner layer of colon wall
Stage 1 Cancer has invaded several layers of bowel but has not grown into outer layer of the wall
Stage 2 Cancer is through the wall but not spread to lymph nodes
Stage 3 Cancer has spread to lymph nodes
Stage 4 Cancer has spread to distant sites in body, e.g. lung or liver

5-year relative survival rate for patients with stage I colorectal cancer is about 90%, for stage II is about 70 to 80% and for stage III is about 40 to 50%. Stage IV is considered the final stage, and patients will usually survive for around two years if they are well taken care of.

Q:

What are the treatment options?

A:

Patients with colon cancer that has not spread to distant sites will typically undergo surgery as the main or first treatment. When the colon cancer has reached an advanced stage of growth and cannot be totally removed, patient will be treated regularly with chemotherapy, radiation therapy and targeted remedy therapies, sometimes in combination with one another (also known as adjuvant treatment). Most adjuvant treatment is given for a duration of about 6 months.

1) Colorectal Surgery

Surgery to remove all or part of the colon is known as a colectomy. For rectal cancer, surgeons will perform low anterior resection (LAR) to connect the rectum to the colon after removing the cancer. An abdominoperineal resection (APR) may also be performed if the rectal cancer is located too close to the anus.

Robotic-Assisted Colorectal Surgery

2) Open Surgery

A large open abdominal incision wmade from the pubic bone to just below the breastbone. Even though is an effective treatment modality but it often involves significant trauma and a long recovery.

3) Laparoscopic surgery

The surgeon will operate through a few small incisions in the abdomen using long-handled instruments and a tiny camera. The camera will send images to a video monitor in the operating room to guide your surgeon during the operation. However, this approach is considered to be technically challenging due to the extensive dissection required and the limitations of traditional laparoscopic technology (2D visualization and lack of dexterity of the instruments).

4) Robotic-Assisted Surgery

In this surgery, the surgeon operates through a few small incisions with the da Vinci robotic surgical system. The surgeon will sit at a console to control the tiny wristed instruments that bend and rotate far greater than a human wrist, all while having magnified 3D HD vision. These features enable surgeons to operate with enhanced vision, precision, and control.

Q:

What are the risks & considerations related to colorectal surgery?

A:

Complication can occur in any surgical procedure, and is not limited to robotic assisted surgery, which may require prolonged hospitalization and/or reoperation. Risks of surgery include but are not limited to injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/ pain. Individual surgical results may vary. Not all patients are suitable candidates for robotic assisted colorectal surgery; patients should talk to their doctor to review all the surgical options which works best for them.

Q:

What are the potential benefits of robotic-assisted colorectal surgery?

A:
  • Excellent clinical outcomes for cancer control
  • Quick return of bowel function
  • Fast return to diet
  • Lesser blood loss
  • Short hospital stay
  • Fast recovery time
  • Lower conversion to open surgery compared to laparoscopic surgery

Q:

How long will robotic-assisted colorectal surgery take?

A:

It depends. Duration of surgery could range between 2 and 4 hours depending on patient anatomy and the extent of surgery, all of which may contribute to a longer duration of surgery.

Q:

How long will I have to stay in the hospital after surgery, and when can I resume normal activities?

A:

After surgery, most patients typically spend 3 to 5 days in the hospital and take approximately 2 to 4 weeks to resume their normal activities.

For important safety information, including surgical risks, indications, considerations and contraindications for use, please also refer to www.davincisurgery.com/safety or www.intuitivesurgical.com/safety

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