Hello and welcome to UHP TV. In this series we're talking about the use of robotics in surgery
and I'm here live in theatre one, one of our 36 theaters here at the Trust.
The trust is leading the way in the southwest in the use of robotics in certain specialities
and I've been joined here today by Sebastian who is the consultant
colorectal surgeon to talk about the use of robotics in colorectal surgery.
Hello Sebastian, so can you talk me through the journey of the use
of robotics in colorectal surgery so far? So the first thing, everything started in
2015 when our urology colleagues bought the robot for the Trust and we as a colorectal
we start introducing ourselves in 2016 but eventually we started in 2020
with the first three cases, and then since that we continue since that. So far we've done 60 cases
and we operate every week on Friday and we mainly use the robot for rectal surgery when
this benefits for the patient is the biggest. And what kind of factors do you need to consider
when understanding whether a patient can have robotic assisted surgery
or general laparoscopic surgery? So obviously with robotic surgery we
now dedicate to more complex cases. And by that we understand the low rectal cancer obviously
in the male pelvis, one is a narrow pelvis where it is difficult to get access with instruments.
We use robot as a clear benefit for the patient. Obviously the robot has a three-dimensional view,
we have a multiple dimension movement of the arms and we can access them access their
operating fields in much better way, and we have a better and stable platform to do the operation.
So you talked a bit about the benefits of doing the surgery in the robotic assisted
way. What are the benefits for the patients and also for the surgeons carrying it out?
So the best benefits for the patient is first of all the operating trauma is way less than any
other operation. We use that only, we don't use any other energy device and and then,
thanks to the robot, the stable platform traction and then great visualization we cut in the right
planes, so the patient has less blood loss and the pain is way less for the patient as well. They're
able to mobilize faster and come back to the to the normal activities, to the normal baseline,
very fast. We know from our data that we cut the length of stay for hospital for our patient,
comparing to laparoscopic for rectal surgery, by two days. So on average our patient goes home say
three/four, sorry three to five and laparoscopic five to seven, so that saves a huge amount of time
for a patient to spend in hospital and they can recover at home, obviously that's great
for hospital because we can treat more patients. From a surgical perspective perspective obviously
after docking the robot we scrub out and scrub off and we sit in the console and so this as
operation takes usually three four or five hours. You sit on a comfortable place, you're not tired,
you don't have to retract it physically, the robot does that for you, you have amazing view,
and you can do better operation for the patient. And that's also better operation
in the way when we see everything it transforms to a better oncological outcome.
And how many patients can we currently treat in this way?
So since we started, we've treated 60 patients so far. We operate every week and we, in fairness
it's great news today because we just bought a new robot and actually arrived to hospital today!
And we are hoping to expand our service, and we probably will be able to treat double this number,
and hopefully with a couple of years - triple. So most of our patients will be
offered robotic surgery in the near future. Wonderful, that sounds truly fantastic. So
we actually do have a clip of the robot in action so Seb can
you talk me through what's happening in this? Of course, so at the moment we are pulling out the
rectum from the from the pelvis and now we're opening the peritoneum to get access to the
main vessel, which provides the blood supply to the rectum, and so we continue towards the
vessel and that you can see the vessel now, it's called inferior mesenteric artery, and we make
creating the window to apply the clips and cut it. So presumably operating in this way,
kind of separate from the patient, feels a bit different to how you're originally trained?
It is. Obviously I've been trained in the robot as well. It takes a little bit of time to get
used to, but it's definitely a very nice way to operate on a patient. And and the way when
you're not physically tired when you do that. And sitting on the console I have stereotactic vision
so I can see the perception, so that's something which we cannot see on laparoscopic surgery.
Now we discontinue the colon from the lateral attachments and that will finish
mobilisation of the colon, we didn't see mobilisation of the splenic flexure, but
please trust me I did it. Now we're opening the peritoneum down towards the pelvis to
be able to fully retrieve the rectum before we move to the mesorectal space.
And what are you kind of feeling and what you're thinking when a process like this is going on?
Obviously you focus on the on the operation. You make sure that you're in the right planes
and you're not causing any bleeding. You want to preserve all the major structures like nerves
which will impact the patients quality of life and so we mainly focus on that. And also I got
my assistant in the back how to perform retraction for me in the colon as we still use the system to
use the retraction. Now we're mobilising very well towards the anus, when the tme plane is
mobilised we're going towards the interstitial space slowly and this is rectum from the bottom,
so the rectum is on the top, and we're dissecting the attachment on the bottom.
Now we're moving towards the front helping the space between the rectum and prostate, you will
very soon see the seminal vesicles, to allow that dissection, we suspend a little bit peritoneum on
the bladder to give us enough traction to be able to see a seminar vesical quite clearly.
And as you said before, a benefit to using robotics in a treatment like this
is that you can get into difficult tight spaces, is that something that's going on here?
Exactly. So if you imagine this is a male pelvis, quite narrow, with bulky mesorectum which is a
fat around the around the rectum, and it's very difficult to get very low with a laparoscopic
instrument which are straight. The articulation of robotic instruments you see allow us to
cut in a multiple dimension and get to the right plane. Now we're going towards..on
the side and we soon should see the seminal vesicles would be in the front.
We get full mobilisation and now we use the stapler to dissect the rectum,
on the junction between the rectum and anus. So what we leave behind is only the muscle and then
one centimetre above them, to perform anastomosis. We use usually two shots to do it,
and as you see direct tumor with a very good mesorectum is now retrieved back.
Thank you so much for that descriptive detail there Seb.
So we've been joined by a patient who had a similar procedure only a few months ago.
This is Clive who's going to be talking us through his journey.
So, Hi Clive, can you tell us a bit about how you came to have your diagnosis? Well basically, the
symptoms I was getting was constipation. And then I was forcing myself to go to the loo and then I
was seeing clots of blood. So then I contacted my GP right away, and she told me she was going to
contact the colorectal clinic and I'll be hearing from them. And that happened within a couple of
days. And by the end of the week I was in here having a colonoscopy. It was all very quick. So
I had the colonoscopy and from that time I was told right away that I had the cancer.
So they brought my wife in and sat her down, so she was a little bit concerned, but really
I knew there was something wrong and I just had to accept it and put my hands into the professionals
to sort it out. And so they they they offered me a lot of uh backup but I really didn't need it.
It all happened so quick, I was in within a couple of weeks for scans, and then I came in and saw
a consultant who explained he had a booklet which explained what what my my cancer was,
and that the piece that was going to be removed, and then from there I went and had a CT scan,
and then I came and met Dr Smolarek and that was the time my mind was really put at ease, because a
couple of days before I had to go and see a stoma nurse there so in case I needed to have a bag,
and I had these two marks on my tummy, and Seb said to me straight away, 'What's that?' I said,
'Well, that's for this little stoma', he said 'You're not having none of that' he said.
And your my mood just lifted straight away. And he explained the operation
and I literally came in the following day. I met him at the entrance to the operating
theater, we came in, we did the consent form and then Seb went one off to get it
scrubbed up, I went in to get myself ready, next thing I knew I was in with the anesthetist
and they put a mask on my face and that's the last thing I knew.
The day after the operation I was straight out and into the chair sat up,
and then I was walking around the following day, and then
within four days - I came in on the Friday, I went home on the Tuesday morning. It was that quick.
And of course it felt a bit strange at first and my mobility was a little bit slow,
but I recovered within a few weeks. That is fantastic!
Oh it's incredible, I can tell you. So it sounds like you went on quite
a journey. Can you describe the kind of emotions and what you were feeling throughout that process?
My emotions...I really didn't emotions because my whole family has suffered with with cancer. I lost
my mum when I was 18 with a tumor on the brain. I've got four sisters and all of them had cancer.
Also my son has had testicular cancer, so I thought I was the odd one out. So
when I heard the news I thought well that's it, and I can now get on with my life because you're
in the hands of these wonderful people here, and that was explained to me in great detail
about this robotic machine and what it does and and I'm the proof of the pudding. I had
five or six holes in my tummy, I haven't been opened up and they've done everything inside
and in the healing procedure it's very quick. So when you first got your diagnosis,
what prompted you to think maybe I've got bowel cancer?
It wasn't until i started seeing the blood that i thought well it must be,
because I saw the advert on the television that told you that if you see blood to contact your GP,
and literally from from phoning the doctor I was diagnosed in September and I had the operation
in the 26th of November. What would you say to somebody who might be on a waiting list
waiting for bowel cancer surgery if they were offered robotic surgery?
Take it. The thing is the doctor explained then but the recovery time
is so quick, everything was done so quick and so efficient.
And then I was back in again in January just to be confirmed that everything went well.
And you've got the all clear now? I've had the all clear, yes.
That is fantastic. Well thank you so much for talking to us today.
So we did catch up with our colorectal consultant and bowel specialist
Mark Coleman who's going to talk us through some preventative measures people can take.
So I'm Mark Coleman I'm a consultant colorectal surgeon or bowel surgeon at University Hospitals
Plymouth and I'm also chairman of Bowel Cancer West which is a regional charity.
Wonderful. So we're talking today about the use of robotics in our colorectal surgery
and as our bowel cancer specialist, could you please give us a bit of information
about preventative measures people can take to avoid the risk of bowel cancer?
Thank you. So yeah, bowel cancer is unfortunately quite a common condition in our community,
particularly affecting in most cases older people but also can affect people of any adult age,
and it is a condition that is more common in developed countries like the United Kingdom
and it is associated with um particularly with poor diet, lack of exercise, and being overweight,
so it's very important to focus on these things throughout one's one's life.
Okay and what kind of patients do we generally see in colorectal?
Okay, so bowel cancer is seen equally in men and women
as I say most of them are elderly, and and we see patients that are coming
who are concerned about symptoms like having blood in their poo if I can use that word,
and just change of their normal bowel habit or any other concerns like abdominal pains or weight loss
and anything else related to the bowels, very happy to see them and there's a very good
two-week wait pathway between primary care or your general practitioner
and the hospital to make sure that patients are seen and investigated in a timely way.
And what piece of advice would you give someone who's just been diagnosed
and what kind of things would you suggest they do as they progress with their treatment?
So it's important to know that early recognition of symptoms early investigation, early treatment
is really important and the message I want to give to patients who are worried about this,
or may have just been diagnosed is in many cases it's a curable condition with the right treatment
and so they can get back to their normal lives many people also
fear and worry about having to have a bag on their tummy otherwise known as a stoma
and actually most of our patients never end up in that situation at all
so really get to your doctor early, get seen, get investigated get treated as soon as possible.
Great advice there Mark. I've been joined again with Seb and Clive to talk about some
questions we've received from national networks, support groups and patients.
So we've got a question here, perhaps for you Seb, from Bowel Cancer UK, asking who
specifically performs the operation? This from a survey they carried out that says perhaps there's
a misconception that the robot was pre-programmed to perform the operation themselves?
We're not there yet! Probably in the next 20 years, but at the moment surgeons
perform the operation, they just stay away from the patient on the console, and use joystick,
and the robot mimics your movements, they are transferred to the robotic arms innovation.
And we've got a good one here for yourself Clive, did you experience any side effects
from your robotic assistant surgery? Well the only thing that happened was,
after you've had the the surgery you are tender, and you and that things are starting
to be placed again, you know that something's missing, that's the first thing that you feel,
and the other thing was if you had to do any heavy breathing or sneezing you could feel that
come down through your tummy, but you know you've got to expect something after having some surgery,
and uh it didn't last long and I can honestly say within three to four weeks that went,
and I was back to normal. Brilliant to hear. You know so I was exercising as I did before,
and getting back to my normal life. Wonderful. So Seb, can you explain
what kind of things patients can expect in the time after surgery?
They also have oral pain relief, so they might get a little bit of discomfort which they can manage
very well. If everything goes according to the plan then day one they can drink, they can
get some light diet, day two they come back to normal kind of diet, they mobilise. We remove
catheter day one, we remove, if any drain left it's removed day one, and usually day three, day
four patients are expecting to go home. Obviously as any operation there are sometimes deviations
from the plan and that's why we keep the patient in hospital for a couple days and not let them go
home day one, but then you know the the biggest fear like with everything in colorectal surgery
is obviously an anastomotic leak, so we are keeping a very close eye on the patient.
Thank you. And thank you to Bowel Cancer UK for those questions. So we've got one in here
from David who asks, who can have robot assisted surgery and why isn't it suitable for everyone?
So almost almost everybody can have robotic surgery. From my for colorectal perspective
who is not suitable is all of people who have quite advanced cancer and they need multivista
resection so for example bladder, prostate, they probably not benefit from robotic surgery,
that operation takes longer, it needs sometimes reconstruction of the pelvic floor, and that's
where the patient won't get the benefits from it. On other side almost everybody can have operation.
And finally we've got one here on a similar theme and an anonymous person has asked
if they are at a disadvantage if they can't have robotic assisted surgery?
You know the robot is just a tool so the most important is operator if someone is very good and
slick with laparoscopic surgery there's not many disadvantage for the patient. Obviously robot and
some like rectal surgery the advantage of robot it's much better, but if you're not able to have
it you know it's better to have laparoscopic surgery than than no surgery or open. But
for like right hemicolectomies there's not many advantages to not doing robotic operation.
So that's all the questions we've got for today. So I'd just like to say thank you
for tuning in to UHPTV, thank you very much to Clive and Seb for talking to us and Mark
for talking to us previously if you'd like to know any more about surgeries and the use of
robotics and surgery here at UHP, tune in to the next one of our series. Thank you for watching.