Robotic and Laparoscopic Colon Resection

WHAT IS THE COLON?

The colon is the large intestine; it is the lower part of your digestive tract. The intestine is a long, tubular organ consisting of the small intestine, the colon (large intestine) and the rectum, which is the last part of the colon. After food is swallowed, it begins to be digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste moves through the colon to the rectum and is expelled from the body. The colon and rectum absorb water and hold the waste until you are ready to expel it.

WHAT IS ROBOTIC AND LAPAROSCOPIC COLON RESECTION?

A technique known as minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.

In most robotic and laparoscopic colon resections, surgeons operate through 3 or 4 small openings (each about a quarter inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.

WHAT ARE THE ADVANTAGES OF ROBOTIC AND LAPAROSCOPIC COLON RESECTION?

Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:

  • Less postoperative pain
  • May shorten hospital stay
  • May result in a faster return to solid-food diet
  • May result in a quicker return of bowel function
  • Quicker return to normal activity
  • Improved cosmetic results

ARE YOU A CANDIDATE FOR ROBOTIC/LAPAROSCOPIC COLON RESECTION?

Although minimally invasive colon resection has many benefits, it may not be appropriate for some patients. Obtain a thorough evaluation by a surgeon qualified in robotic and laparoscopic colon resection in consultation with your primary care physician to find out if the technique is appropriate for your condition.

What Preparation is Required?

Advance tests…

Most diseases of the colon are diagnosed with one of two tests: a colonoscopy or barium enema. A colonoscope is a soft, bendable tube about the thickness of the index finger which is inserted into the anus and then advanced through the entire large intestine. A barium enema is a special X-ray where a white “milk-shake fluid” is flushed into the rectum and by using mild pressure is pushed throughout the entire large intestine. These tests allow the surgeon to look inside of the colon. In addition a CT scan of the abdomen may be necessary.

Preparing for surgery…

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Blood transfusion and/or blood products may be needed depending on your condition. Although rare, blood transfusion and/or blood products may be needed
  • It is recommended that you shower the night before or morning of the operation.
  • Your surgeon may want your colon and rectum to be completely empty before surgery. If this is the case, you must drink a special cleansing solution. You may be on several days of clear liquids, laxatives and enemas prior to the operation.
  • Antibiotics by mouth are commonly prescribed. Your surgeon or his/her staff will give you instructions regarding the cleansing routine to be used.
  • Follow your surgeon’s instructions carefully. If you are unable to take the preparation or the antibiotics, contact your surgeon.
  • If you do not complete the preparation, it may be unsafe to undergo the surgery and it may have to be rescheduled.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications), Fish oil, and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

HOW IS ROBOTIC AND LAPAROSCOPIC COLON RESECTION PERFORMED?

“Laparoscopic” surgery describes the techniques a surgeon uses to gain access to the abdominal cavity. A specialized camera called a laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula (a narrow hollow tube like instrument). At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working space for the surgeon. The laparoscope transmits images inside the abdominal cavity , giving the surgeon a magnified view of the patient’s internal organs on a television monitor.

Several other cannulas are inserted to allow the surgeon to work inside and remove part of the colon. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions.

Robotic surgery is an extension of the laparoscopic technique. The surgeon will attach the robot to the cannulas. Visualization is made through a similar robotic laparoscope. He will then maneuver and control the robot to complete the operation as described in the laparoscopic section. There are some advantages to using robotics that may assist the surgeon in certain situations.

After Surgery

WHAT SHOULD I EXPECT AFTER THE SURGERY?

After the operation, it is important to follow your doctor’s instructions. Although many people feel better in a few days, remember that your body needs time to heal.

  • You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
  • You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, working and engaging in sexual intercourse.
  • There are exercising and lifting restriction that your surgeon will review with you prior to your surgery.
  • Call and schedule a follow-up appointment within 2 weeks after your operation.

WHAT COMPLICATIONS CAN OCCUR?

These complications include:

  • Bleeding
  • Infection
  • A leak where the colon was connected back together.
  • Injury to adjacent organs such as the small intestine, spleen, ureter, or bladder
  • Blood clots in deep veins in your legs that may travel to your lungs.

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you notice severe abdominal pain, fevers, chills, or rectal bleeding.

When to Call Your Doctor

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101 degrees F (39 C)
  • Bleeding from the rectum
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids

Adapted from SAGES