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Robotic Colorectal Surgery

What is Robotic Colorectal Surgery?

Colorectal surgery is the surgical removal of all or a part of the colon or the rectum. The colon is also known as the large intestine or large bowel. The rectum is the lower part of the large intestine that is connected to the sigmoid colon (lowermost part of the colon). The colon and the rectum function to store and expel processed food and waste.

Robotic colorectal surgery is the use of robotic technology for the surgical excision of the diseased section or cancerous tissue of the colon or rectum for the treatment of colorectal conditions. It is a form of a minimally invasive surgical procedure developed to overcome limitations of laparoscopic colorectal surgery. Robotic surgery offers high-quality visualization of the treatment site and much more precision in instrumentation compared to standard laparoscopic surgery.

Indications for Robotic Colorectal Surgery

Robotic colorectal surgery is indicated for the treatment of colorectal conditions such as:

  • Colon polyps or cancer
  • Rectal polyps or cancer
  • Crohn’s disease
  • Diverticulitis
  • Hemorrhoids
  • Ulcerative colitis
  • Rectal prolapse
  • Fistula involving the rectum and colon
  • Endometriosis involving the rectum or colon
  • Other colorectal issues requiring surgery

Preparation for Robotic Colorectal Surgery

Pre-procedure preparation for robotic colorectal surgery will involve the following steps:

  • A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
  • You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Robotic Colorectal Surgery

Robotic colorectal surgical systems involve two machines, a control unit or the surgeon’s console, and a patient unit. The surgeon sits at the control unit, away from the operating table, and controls the movement of the four robotic arms of the patient unit, present near the operating table. One of the robotic arms holds and positions a 3D high definition camera through the incision in the operated area providing images of the operation site to the surgeon at the control unit. These images are high-resolution 3D images, superior to the 2D images in the laparoscopic approach, and can also be magnified by 10 to 12 times. The other three robotic arms are used to hold small miniature instruments, which are used for the surgery. These instruments are introduced through the tiny (1-2cm) incisions over the patient’s abdomen. These miniature instruments are more flexible compared to the long handled rigid instruments of traditional laparoscopic surgery. A wide range of these instruments is available to the surgeon to perform various specialized surgical tasks. The robotic arm cannot be programmed to do the surgery on its own. Instead, it translates the surgeon’s hand movements at the control unit into precise movements of the micro-instruments in the operation site, minimizing tremors that may occur from unintended shaking of the surgeon’s hands. The enhanced vision and superior control of the micro-instruments help in the precise removal of the cancerous tissue or diseased section of the colorectal area without damaging the nerve fibers and the blood vessels nearby. The incisions are then closed, and a bandage is applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after robotic colorectal surgery will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions to the medications and anesthesia used. Your nurse will also monitor your blood oxygen level and other vital signs as you recover.
  • You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
  • Medications may also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
  • Walking and moving around in bed is strongly encouraged as it lowers the risk of blood clots and pneumonia. It also helps to stimulate your bowels and assist with passing gas.
  • Antibiotics are prescribed to address the risk of surgery-related infection.
  • Your diet is slowly advanced post surgery. You will start with clear liquids and then progress to having normal solid foods, as tolerated.
  • It is important to keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking for a specific period of time as it can negatively affect the healing process.
  • Refrain from strenuous activities and lifting anything heavier than 10 pounds for the first couple of months. A gradual increase in activities over a period of time is recommended.
  • Eating a healthy low fat, high fiber diet is strongly recommended to promote healing and a faster recovery as well as drinking 8 to 10 glasses of water daily to prevent constipation. Laxatives or stool softeners may also be recommended as needed.
  • Most patients are discharged after 2 to 3 days of hospital stay. You will need to take off work at least a week or two to rest and promote healing. You may take a month or two until you begin to feel back to normal.
  • Walking is a good exercise and is strongly recommended to improve your endurance.
  • Refrain from driving until you are fully fit and receive your doctor’s consent. Most patients can resume driving around 2 to 4 weeks following surgery.
  • You will be able to resume your normal activities within a couple of weeks but may have certain activity restrictions.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Robotic Colorectal Surgery

Some of the benefits of robotic colorectal surgery over conventional laparoscopy surgery include:

  • Enhanced precision, vision, and control
  • Less pain
  • Tiny surgical scars
  • Minimal blood loss
  • Minimal risk of infection
  • Quicker recovery
  • Minimal muscle trauma
  • Lower risk of damage to adjacent soft tissue structures
  • Minimal discomfort
  • Shorter hospital stay
  • Minimal trauma to skin and muscles
  • Improved safety and cosmetic outcomes

Risks and Complications of Robotic Colorectal Surgery

Robotic colorectal surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Hematoma (accumulation of blood in the wound)
  • Seroma (accumulation of clear fluid in the wound)
  • Damage to nerves, vessels, and organs
  • Post-procedure pain
  • Blood clots
  • Bowel/bladder problems
  • Allergy/anesthetic reactions