Current Trends in Robot-assisted Surgical Treatment for Colorectal Cancer
Colorectal cancer is the second most common type of cancer in the US. According to the estimates derived by the American Cancer Society, 101,420 new cases of colon cancer and 44,180 new cases of rectal cancer are expected to be diagnosed in the United States during 2019.
Colorectal cancer is also the third leading cause of cancer-related deaths and about 51,020 deaths are expected to occur in 2019.
However, the death rate from colorectal cancer, which is the number of deaths occurring per 100,000 people per year, has been decreasing in recent years. The reasons for this could be a higher number of early diagnoses, which allows removal of colorectal polyps before they develop into cancer and advanced treatment methods that enhance the quality of life for patients with colorectal cancer. Currently, there are over 1 million colorectal cancer survivors in the United States.
Robot-assisted surgery is a novel treatment method for colorectal cancer. The technical advances in robotic surgery have improved surgical performance as well as clinical outcomes because of which robotic colectomy is considered safe and feasible compared to conventional surgeries. The potential advantages of robot-assisted surgery include:
- Better three-dimensional visualization, proper magnification providing better identification of pelvic floor structures
- Steady instrumentation
- Ability to maneuver even in constrained anatomical space.
These features have strengthened surgeon’s hopes of removing rectal cancer completely as these type of cancers are usually located deep within the pelvis and in close proximity to important structures, making the resection quite a challenging task. Further, technological advances such as stapling devices and smart clamps enable surgeons to perform sectioning of the bowel with ease.
At Marina Del Ray Hospital, our surgeons perform robotic colorectal surgery using the da Vinci® Surgical System. Several studies have suggested that patients who had undergone colectomy with da Vinci® Surgical System had a quick return of bowel functions compared to those who had conventional open surgery. In addition, patients who had da Vinci® rectal resection could return to a soft diet much faster.
Technological Advances in Robotic Surgery
There have been remarkable advances in the field of robotic colorectal surgery after its advent back in 2001. The current trends and technical advances in the field of robotic colorectal surgery are summarized below:
- Recent studies have reported the technique called Extralevator Abdominoperineal Resection (ELAPR), which has made robotic surgery feasible and useful in challenging cases such as resection of low rectal cancer located in the narrow pelvic cavity.
- Robotic pelvic exenteration: This technique is used to treat locally advanced rectal cancer that invades the prostate gland and seminal vesicles.
- Intraoperative Near-Infrared Fluorescence (INIF) Imaging System: The INIF system makes use of laser technology to show an intravenously delivered dye such as activated indocyanine green dye. This imaging has been developed to identify vascular anatomy easily and detect tumor location in real time while performing surgery. This system also makes robot-assisted colorectal procedures safe and effective. It also makes the lymph node dissection even more precise.
- Reduced-port robotic surgery: Recently, a robotic single-access platform similar to the da Vinci Single-Site Port was used for left-sided colorectal cancer surgical resection. Single port robotic surgery requires less operative time when compared to other robotic surgery techniques. It also facilitates proper dissection and provides good outcome cosmetically.
- Da Vinci Xi System: The da Vinci Xi robotic system has a slim and simple design with flexible, movable top roofing. The new platform has a light camera scope with autofocus and camera lens that is situated at the tip of the scope. The camera scope can be attached to any of the robotic arms. The innovation was made to overcome the limitations of robotic da Vinci Si version such as fixed heavy arms, the need for re-docking, and risk of collisions.
- Endowrist®Da Vinci Xi Stapler: Staplers provide surgeons with flexibility with 360-degree rotation and articulation as well as natural dexterity. It can estimate the thickness of tissue and study the viability and vascularity of the bowel. Robotic staplers are evidence of smartness of the robotic system and are directly controlled by the surgeons.
The robotic surgical procedure has been able to overcome limitations of laparoscopic technique in colorectal surgery and at the same time ensures improved postoperative outcome and shorter hospital stay for patients.