First Things First. Anatomy. Then, What Can a Surgical Robot Do?
Colon Cancer. Rectal Cancer. Terms that cause fear in all of us. In big cities such as Los Angeles and in small towns alike, colorectal cancer is common. It is the third most common cancer overall. Once discovered, an operation is usually performed as soon as possible by a colon and rectal surgeon, also known as a proctologist.
Anatomy
The colon is a hollow muscular tube which helps to form and store our stool, or bowel movement. The stool is retained in the rectum until a convenient time is found for the passage of a bowel movement. The colon has several parts, with the right side of the colon thought of as the water resorptive part, and the left side and rectum thought of as the storage area. In the past, cancers affected the left side most often. Now, cancers seem to affect both the left and right sides equally. (Hence, the importance of a colonoscopy; to detect the presence of problems on the right side, far from the reach of traditional short scopes used in your proctologist’s office. A proctologist is also known as a coloproctologist, or colon and rectal surgeon).
The Operation.
The operation to remove colorectal cancer is performed in the hospital setting, in an operating room. After a bowel preparation (cleansing) the surgeon removes the cancerous portion and reattaches the two ends of the colon. The attachment is called an anastomosis.
Originally, a large incision was used to enter the abdomen. While successful, this type of operation caused much postoperative pain. With the advent of laparoscopic surgery (also known as minimally invasive surgery), the same operation was performed through tiny incisions on the abdominal wall, using instruments inserted through those incisions.
The Surgical Robot. The da Vinci Si®
Recently a surgical robot, the da Vinci Si®, has been developed to allow the surgeon to use even smaller incisions. Instruments attached to robotic arms, completely and exclusively controlled by the surgeon, remove the tumor and help reconnect the normal pieces of colon. Cedars-Sinai Medical Center in Los Angeles has the da Vinci Si® in it’s operating rooms, available for use by the select group of specially trained and certified colon and rectal surgeons of Los Angeles Colon and Rectal Surgical Associates.
One of the traditional problems associated with colon operations, has been the problem of anastomotic dehiscence, or the anastomosis developing a small hole and a subsequent leak. As you can imagine, this would cause quite a problem.
Firefly™
Firefly™, the use of indocyanine green (ICG) injected intravenously during the operation, travels through blood vessels and can actually show the surgeon the quantity and quality of the blood flow to the colon and the anastomotic area. It uses near-infrared fluorescence to image the ICG and help the surgeon understand the adequacy of the blood flow. It is thought that this technology might decrease the incidence of anastomotic leaks. A strong and adequate blood is crucial to the integrity of the anastomosis. It has shown promise in this regard.
A smooth, easier recovery period allows patient to return to the activities of daily life, much quicker. The robot is an important step in this regard.
Los Angeles Colon and Rectal Surgical Associates.
Each of the surgeons of Los Angeles Colon and Rectal Surgical Associates is trained and certified in the use of the robot. Each is a leader in the field of robotics in the hospital setting. Contact one of the surgeons to see if the robot has a place in your treatment plan. (310)273-2310.
