Robot Colectomy

Overview

Your colon is a part of your large intestine where waste from your digesting hardens into stool. Your large intestine extends after your colon into your rectum and anus, where food waste departs your body.

A colectomy is a surgical procedure that removes all or part of your colon. It is also known as colon resection surgery. Because your colon is a portion of your large bowel, colectomy is a form of big bowel resection.

For a variety of reasons, you may need to have part or all of your colon removed. Cancers and diseases that cannot be treated with drugs are examples of this. Removing the damaged section allows the rest of your gastrointestinal tract to operate normally.

 

Is a Colectomy a Major Surgery?

The vast majority of individuals would concur. While there is no standard definition of major vs. minor surgery, colectomy requires a prolonged operating time and a six-week recovery period, both of which are on the longer side. A colon resection also changes the way food flows through your gastrointestinal tract. Some forms of colectomy may alter your restroom habits in the future.

Colectomy surgery can be conducted utilizing minimally invasive procedures if the conditions are favorable. If you are a candidate for laparoscopic or robotic surgery, your operation and recovery time will be shortened. Laparoscopic and robotic surgery employ smaller incisions than traditional open surgery, resulting in faster recovery and less overall discomfort. The type of procedure you get will be determined by your condition.

 

Types of Colectomy

You may need all or only part of your colon removed. Operations to remove different sections of the colon have different names.

 

Total colectomy

A total colectomy involves the removal of your whole colon. The majority of your big intestine is located here. It starts at the end of your small intestine and terminates at the rectum, which is the tail end of your large intestine that feeds into the anal canal.

 

Partial/subtotal colectomy

A subtotal or partial colectomy involves the removal of a piece of your colon. Your procedure may be referred to by a more specific name that refers to the portion of your colon that is being removed. As an example:

• Colectomy of the sigmoid. A sigmoid colectomy, sometimes known as a sigmoidectomy, is a surgical procedure that removes the final piece of your colon, known as the sigmoid colon. This is the section that attaches to your rectum.
• Hemicolectomy. A hemicolectomy involves the removal of one side of your colon. The descending colon, which runs downhill on the left, is removed during a left-side hemicolectomy. This is located in the second portion of your colon. The ascending colon, which runs upward on the right side, is removed during a right-side hemicolectomy. This is around half of your colon.
• Proctocolectomy. A proctocolectomy involves the removal of a portion of the colon as well as the rectum. "Procto" is Latin for "rectum." (A total proctocolectomy involves the removal of the whole colon and rectum.)

 

When Robot Colectomy is Indicated?

Robot colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:

1. Uncontrollable bleeding. Severe colonic bleeding may necessitate surgery to remove the damaged part of the colon.
2. Obstruction of the bowel. A blocked colon is a medical emergency that may necessitate whole or partial colectomy, depending on the circumstances.
3. Cancer of the colon. Early-stage tumors may only necessitate the removal of a tiny piece of the colon during a colectomy. Later-stage cancers may necessitate the removal of more of the colon.
4. Crohn's disease. If drugs aren't working, removing the damaged portion of your colon may provide temporary relief from symptoms. Colectomy may also be a possibility if precancerous alterations are discovered after a colonoscopy.
5. Colitis with ulcers. If drugs aren't controlling your symptoms, your doctor may prescribe complete colectomy or proctocolectomy. If precancerous alterations are discovered after a colonoscopy, a proctocolectomy may be advised.
6. Diverticulitis. If your diverticulitis recurs or you have difficulties from it, your doctor may prescribe surgery to remove the diseased part of the colon.
7. Preventive surgery. If you are at a high risk of developing colon cancer as a result of the creation of many precancerous colon polyps, you may choose to have a complete colectomy to avoid cancer in the future. People with inherited genetic disorders that enhance the risk of colon cancer, such as familial adenomatous polyposis or Lynch syndrome, may be candidates for colectomy.

Discuss your treatment options with your doctor. In some situations, you may have a choice between various types of colectomy operations. Your doctor can discuss the benefits and risks of each.

 

When Robot Colectomy is Contraindicated?

There are no definite contraindications to colectomy; however, the patient's overall medical state and the reason for surgery should be considered on a case-by-case basis.

A classic difficult case is a patient with substantial heart disease who has a large polyp in the cecum that cannot be removed colonoscopically. The risks and benefits of the surgical procedure must be balanced against the predicted consequences of the physician's inactivity. A patient who has a severe cardiac condition or is unable to endure anesthesia may be disqualified for surgery. It should be common practice to discuss potential implications with the patient and his or her family.

In terms of method, laparoscopic colectomy has several relative contraindications. Because of intra-abdominal adhesions or scar tissue from past abdominal surgical procedures, a laparoscopic procedure may be ruled out. In addition, phlegmon from perforated diverticulitis might complicate laparoscopic colectomy.

The patient's inability to tolerate insufflation, as with all laparoscopic abdominal surgeries, is a contraindication for laparoscopic colon resection. Patients suspected of having breathing difficulties should have preoperative pulmonary function tests.

The surgeon should also take note of any bleeding disorders or liver problems the patient has. Though not an absolute contraindication, portal hypertension can result in significant bleeding intraoperatively, a dangerous and difficult scenario to control even in the best of circumstances.

Finally, if a 15-cm tumor must be removed or if a tumor is infiltrating the abdominal wall muscle or pelvic attachments, the choice to do laparoscopy may be influenced by the particular surgeon's skill set.

 

What is the Difference Between Colectomy & Colostomy?

A colectomy is a surgical procedure that removes part or all of your colon. But what happens to the rest of your intestine once the diseased tissue has been removed? This fluctuates based on a number of circumstances. Sometimes the two remaining ends of your intestines can simply be stapled together during the same operation, allowing your digestive tract to work normally. However, this is not always achievable. In this instance, an ostomy — either an ileostomy or a colostomy — may be required. Ileostomy or colostomy can be either temporary or permanent.

An ostomy is another surgical treatment that establishes a new channel for your poop to go when the normal path is blocked. If your system is unable to transport your food waste via your rectum and out through your anus, you will need to find another means for your poop to exit. A colostomy or ileostomy allows waste to exit your body through a hole in your abdominal wall known as a stoma. To collect poop, an ostomy bag is attached to the outside of the stoma.

Not all colectomies necessitate the use of an ostomy, and not all colostomies are permanent. You may only require one while your intestines recover from the colectomy. Many ostomies are reversible after a few months, depending on your condition. You may need to return to surgery to have your intestines reconnected (anastomosis) and your stoma closed. Others could require a permanent ostomy.

 

Open vs. Laparoscopic/Robotic Surgery

Your surgeon may perform your colectomy by traditional open surgery or by minimally-invasive laparoscopic surgery.

1. Open surgery means opening up your abdominal cavity through one long incision. This method provides the easiest access to your organs and may be necessary when your case is more complicated, or if you are having emergency surgery.
2. Laparoscopic/robotic surgery Laparoscopic surgery is conducted through a series of small incisions with the use of a tiny video camera known as a laparoscope. If you are having a laparoscopic/robotic colectomy, the surgeon will start with a single tiny incision to insert the laparoscope. They'll inject gas through the incision to expand your abdominal cavity and project your organs onto a TV screen. One or more further small incisions will allow your surgeon to reach your colon with special instruments through one or more additional minor incisions.

 

How Do You Prepare for Robot Colectomy?

Health screening

Before scheduling a colectomy, your healthcare team will evaluate your fitness for surgery. In addition to a physical exam and health history, this may include:

• Blood tests.
• X-ray.
• Electrocardiogram (EKG) test.
• Urinalysis.
• Colonoscopy.

 

Pre-operative counseling

Your healthcare team will want to make sure you understand everything about the procedure before you sign your consent. They’ll counsel you about:

• Surgical risks.
• Living with a colostomy, if you’re going to have one.
• Options for pain management.

 

Bowel preparations

When you have surgery on your bowels, it’s important for them to be empty. You’ll need to prepare for this a couple of days in advance. Your healthcare provider may ask you to:

• Consume only a clear liquid diet.
• Fast before the procedure (no food or drinks).
• Take a laxative or enema to clear out your bowels, like polyethylene glycol (Miralax®). These bowel preparations come with their own specific instructions.

 

How Robotic Colectomy is Done?

All robotic procedures are done in an operating room, with a specially trained surgical staff. Patients are under general anesthesia, and constantly monitored by an anesthesiologist.

To begin the procedure:

• The surgeon makes 4 – 6 small incisions in the abdomen
• The abdomen is inflated with carbon dioxide to give the surgeon room to work
• Specially designed surgical instruments and a tiny camera are attached to robotic arms and precisely inserted through the incisions
• The surgeon then sits at a nearby console, controlling every movement of the robot arms

If the colectomy is done in the colon, the surgeon:

• Cuts the colon on either side of the diseased segment
• Removes the segment through one of the incisions
• Inserts a seal and sutures the two new ends together

If the colectomy is done in the colon, the surgeon:

• Carefully resects (or frees) the rectum from where it is attached
• Ties off the blood supply
• Divides the rectum to separate the part that needs to be removed
• Removes the selected section
• Puts everything back together

Once the procedure is complete, the camera and surgical instruments are removed and the abdominal incisions sutured closed. If a colostomy is needed, it is created at one of the incisions sites.

 

Benefits of Robotic Colectomy

The body must mend from the big incision in the belly that slices through tissue and muscle during an open colectomy.

You will be in the hospital for four to five days if you have open surgery. In five to eight weeks, you'll be able to return to some of your normal activities.

In comparison, people who have a robotic colectomy:

• Stay in the hospital three to four days
• Are often back to work in two weeks
• Experience much less pain

Laparoscopic rectal colectomy is particularly challenging. The rectum is contained in the pelvis and difficult to access. Also, the surgery is viewed on a 2-D flat screen.

In comparison, robotic surgery gives the surgeon:

• Flexible surgical instruments that mimic the movements of the surgeon's wrist
• A 3-D field of view at the console
• The field of view is also magnified to give the surgeon a close look

A better experience for the surgeon often means a better outcome for the patient, including less chance of complications.

 

Recovery

How soon you recover from a colectomy is determined by the scope of the procedure. The length of your hospital stay will be decided by the surgery you undergo and the amount of time you need to recover.

You will be given information on how to care for your surgical incisions and stoma (if present), as well as any additional instructions before leaving the hospital. A highly trained stoma nurse/therapist will provide you with extensive instructions on how to care for your stoma (if present).

Your medical team will go through the medications you will be taking with you, including those for pain, blood clot prevention, infection prevention, and constipation prevention, as well as those for other conditions.

Your provider will advise you what you should and should not do when you get home. This typically includes:

• Do not lift anything heavier than a particular weight, climb, or engage in intense exercise unless you are advised you may.
• Change your diet as directed. Following surgery, you may be instructed to follow a low-residue (low fiber) diet.
• Unless otherwise directed, drink 8 to 10 glasses of water each day.
• Try not to strain to have a bowel movement.
• Do not drive if you are under the influence of pain medication.
• Depending on your career, you may usually return to work in 2-3 weeks.
• Discuss showering, immersing surgical incisions in water, food, sexual activity, and stoma care with your healthcare team.

 

Risks

Colectomy has the potential for significant consequences. Your risk of problems is determined by your overall health, the type of colectomy you have, and the method your surgeon takes during the procedure.

In general, complications of colectomy can include:

• Bleeding
• Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)
• Infection
• Injury to organs near your colon, such as the bladder and small intestines
• Tears in the sutures that reconnect the remaining parts of your digestive system

Following your colectomy, you will be admitted to the hospital to allow your digestive system to heal. Your medical team will also keep an eye out for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.

 

Conclusion

In general, minimally invasive surgery necessitates fewer, or smaller, incisions. However, robotic colectomy differs from laparoscopic colectomy. It employs robotic technologies to improve accuracy and control while magnifying the colon, surrounding tissue, and blood arteries.

Surgical equipment (as well as a small camera) is mounted to robotic arms during a robotic colectomy. A very experienced surgeon controls these arms from a nearby computer station.

The robotic arms mimic your surgeon's movements of his or her hand, wrist, and fingers in real-time. The robotic arms not only mimic delicate motions, but they can also bend and spin in ways that a human hand cannot. This may make it simpler to reach difficult-to-reach parts of the body.

A high-definition, close-up view of the surgical site is also displayed on the computer interface. During the surgery, your surgeon will be able to look within your body in three dimensions. Another significant difference is that surgeons only have a two-dimensional view of the surgical field during laparoscopic colectomy.

Several tiny incisions in your lower abdomen are used by the surgeon to gain access to your colon during the surgery. He or she meticulously isolates your colon from surrounding tissue before removing it through one of your abdominal incisions.