Robotic colorectal surgery with the Da Vinci® robot, allows for the benefits of minimally invasive surgery, along with the fine precision, 3D vision and magnified view afforded only by robotic surgery.
Its main advantage over open surgery is the avoidance of large incisions. The improved visibility and dexterity of robotic surgery allow for less blood loss, shorter hospital stay and faster recovery compared with open surgery.
Its main application is for difficult surgery low in the pelvis, making it particularly suitable for low rectal surgery including that for rectal prolapse and rectal cancer. Robotic surgery has been shown now to take slightly longer than conventional laparoscopic surgery [1] but results in improved resection margins and less blood loss. With improved resection margins, the risk of inadvertent nerve injury and sexual dysfunction is thought to be less.
How does robotic surgery work?
Though often called “robotic surgery”, the surgery is entirely performed by your colorectal surgeon, with miniature robotic arms inserted through just a few tiny openings. The da Vinci system has been used successfully worldwide in hundreds of thousands of procedures to date.
Transanal Surgery using the robot?
Transanal surgery using the robot was first performed in Australia in 2015 by Sydney colorectal surgeon Dr Gary McKay [2]. The robot has certain advantages over previously used techniques for removing tumours or large polyps from the rectum via the anus. This is largely due to the ability of the robot’s small miniaturised robotic hands to perform complex movements including suturing within the very narrow confines of the rectum. The benefit of such surgery is the avoidance of major abdominal surgery and preservation of the rectum and bowel continuity.
Where is robotic surgery available?
Robotic surgery with the latest XI model is available at Mater Private Hospital, Westmead private Hospital and St George Private Hospital. .
What is the added cost of robotic surgery?
Robotic surgery is not yet fully reimbursed by all health funds or Medicare, therefore there may be some additional costs that you will need to discuss with your colorectal surgeon.
What to expect pre and post operatively for robotic colorectal surgery
You will need to have only clear fluids the day before your surgery. Clear liquids are those that one can see through. When a clear liquid is in a container such as a bowl or glass, the container is visible through the substance. You will also require bowel prep to clean your colon. Take a Pico-sulfate (Picoprep®) prep at 2pm 4pm and 6pm the day before your procedure. You need to fast from midnight the night before if your surgery is scheduled for the morning, or from 6am if scheduled for the afternoon. Immediately after your procedure you will be commenced on free fluids (semi thickened fluids such as custard, yoghurt, thin porridge). The small incisions of robotic surgery allow you to mobilise from day one. You will be commenced on a light diet once you have passed flatus. You will be discharged from hospital once you have opened your bowels. A typical admission is anywhere from 3 days to 7 days.
Post operatively, you will need to see your colorectal surgeon at 3-6 weeks post-operatively to check on your progress. If your surgery is for cancer, you will then be followed up regularly (every 1-3 years), with colonoscopy performed at regular intervals.
References
- Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis.Ann Surg. 2010 Aug;252(2):254-62.
- Lajevardi SS, Tameev Z, McKay G. Robotic Transanal Endoscopic Submucosal Dissection (RTESD) of Large Rectal Tumor in Prone Position. J Minim Invasive Surg Sci. 2016 May; In Press(In Press):e34095.
