Robotic Colectomy

Colectomy is the surgical removal of part or all of the colon (and/or rectum) and the lymph nodes draining the area, when conditions develop that require surgical excision. Once the affected part of the bowel is removed, the two remaining healthy parts are reconnected, performing what is known as an anastomosis, which can be done endoscopically or extracorporeally.

Colectomy is performed to treat serious colon/rectal conditions such as cancer, diverticulitis, inflammatory conditions (such as Crohn’s disease, ulcerative colitis), bowel obstructions and other conditions that can affect quality of life and need to be treated with surgical exclusion.

Colectomy can be performed by the traditional open method, which requires very large incisions in the skin and muscles to allow for a direct view of the affected area. Open colectomy has serious disadvantages, as it is associated with significant post-operative pain, many complications and wound infections, many days of hospitalisation and the inability to return to daily life quickly. That is why nowadays we try to perform colectomy with minimally invasive techniques, such as laparoscopic and robotic methods.

Robotic colectomy is the most advanced method of minimally invasive surgery, which allows us to operate with more precision, flexibility and control than traditional laparoscopy.

In a robotic colectomy, the surgeon can remove part, or all, of the colon through a few small holes of a few millimetres, with the help of the robotic system (da Vinci).

The da Vinci robotic system consists of 3 parts, the surgeon’s console, the patient cart, which is placed on the patient and the robotic instruments are connected, and the vision cart, which supports the visual system and enables communication between the 3 parts of the robotic system.

During the surgery, the surgeon sits at the console and operates with the help of special remote controls that mimic and transmit his movements with great accuracy, while correcting the tremor, in order to move the robotic arms to which the robotic instruments are attached; the robotic instruments are not straight but break and follow the movements of the wrist (wristed articulated instruments), and have great flexibility of movement, so that the surgical operations are very controlled and precise (Focused precision surgery).

The surgeon sees through a camera, high-definition, three-dimensional, 10 times magnified image; it is as if we are inside the patient’s body and we see structures that we could not see with any other method.We can more easily perform endosomal anastomoses and radical lymph node cleanings, which are much more difficult to do with the laparoscopic method. We can use robotic ”firefly” technology, which is fluorescence imaging that offers visualization beyond the human eye to clearly highlight blood flow in the colon and tissue perfusion to allow us to have safer anastomoses. Using Artificial Intelligence (AI) and Augmented Reality (AR) technology, we can personalise procedures by performing 3D reconstruction of each patient’s vessels; and then safely perform radical lymph node cleanings, which, in cancer patients and depending on the stage of the disease, can increase survival by 10-17% .

In conclusion, the advantages, as supported by the literature, are multiple, such as:

• Less postoperative pain
• Less complications
• Shorter hospital stay
• Shorter incisions
• Faster return to daily functions
• Less blood loss
• Fewer Surgical Trauma Infections
• Less surgical trauma
• Standardization of surgical technique
• Reduction of permanent stomas (despite the nature of the seat)
• Increase in the number of surgeries that can be performed Minimally invasive
• Reduction of conversion to open surgery intraoperatively
• Oncological benefits
• Reduction of the infiltrated resection margin
• (positive CRM)
• Lower number of local recurrences