Robotic Surgery Offers Greater Surgical Precision in Colon Cancer Removal

Daniel Marcus';

By Daniel Marcus

Posted on November 25th, 2019 in Robotic Center

Every year, more than 40,000 people in the United States develop rectal cancer and most of these tumors are low-lying, which means that the tumor develops almost at the end of the colon.

The position of the tumor presents a major challenge for the surgeons because it is technically very difficult to access and there is a restricted view of the operating area because of the anatomically constricted lesser pelvis.

In addition, the neuroplexus surrounding the area is very dense and sensitive, and any damage to the nerve can cause incontinence or loss of sexual function.

Robot-Assisted Surgery - a Novel Treatment Method for 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 surgeons' hopes of removing rectal cancer completely as these types 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.

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 the robotic da Vinci Si version such as fixed heavy arms, the need for re-docking, and the 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 the tissue and study the viability and vascularity of the bowel. Robotic staplers are evidence of the smartness of the robotic system and are directly controlled by the surgeons.

The robotic surgical procedure has been able to overcome limitations of the laparoscopic technique in colorectal surgery and at the same time ensures improved postoperative outcome and shorter hospital stay for patients.

Studies Suggest that Robotic Surgery Is Advantageous

Robotic surgery has clear advantages over the open or laparoscopic surgical methods, specifically in constricted anatomical positions such as the lesser pelvis. Moreover, studies have shown that surgeons can easily learn the robot-assisted method compared to the laparoscopic procedure and experience less fatigue because of better ergonomics. Overall, robotic surgery can be considered the standard procedure for the removal of colorectal tumors, especially low-lying rectal cancers.

Our Surgeons Use Robotic Surgery to Treat Colon Cancer

For colon cancer patients who require surgery as part of their treatment, our medical specialists rely on robotic surgery to help remove hard to reach tumors, shorten surgery times or lessen side effects for patients compared to conventional surgery.

At Cedars-Sinai Marina del Rey 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.