Hello I'm Charlie. I'm a consultant general colorectal surgeon at the
University Hospital Coventry, Warwickshire. Some patients will develop worrying
symptoms with their bowels, this may be a change in bowel habits, they may develop
diarrhea, they may notice some blood within their stool. They may also find
that they have a mass within their tummy or have unusual pains. These will need
investigating. The most usual tests for the bowels are a coloscopy or a
flexible sigmoidoscopy. Alternatively sometimes you may have imaging such as a
CT scan. If these tests find a worrying lesion, this will need further
investigation. If these investigations identify a worrying lesion, there is a
high chance that this could be a bowel cancer. All bowel cancers need complete
staging which includes a CT scan of your chest, abdomen, pelvis but also if the
lesion is within the lower bowel, the rectum, you will also need an MRI scan of
the pelvis. Once all this imaging has been performed and the information from
the test put together, it will be discussed at a multidisciplinary team
meeting, where you have cancer specialists, bowel surgeon specialists,
pathologists and x-ray doctors. A lot of patients at this point will be referred
on to surgeons for an operation to remove the tumour. These operations are
generally done by specialist colorectal surgeons
can be done either as open operation or keyhole operations. The majority of
surgeons doing keyhole operations do them as standard laparoscopic operations. However,
an increasing number are performing them robotically.
Robotic surgery in the UK is most commonly performed using the DaVinci device made by Intuitive. There are three parts
to the robotic device. The surgeon console, the patient side cart and the
vision stack. The surgeon sits at the console while the patient has a side cart
attached to instrument it that go within the patient's abdomen. The surgeon console
allows a surgeon to see in 3D, high-definition within the body. This is
really important when you're trying to operate in a precise way in a narrow
difficult area. There is also control of the instrument through the console. The
surgeon uses pincers to move the instrument, so as the surgeon moves his
hand, the instrument is carefully and precisely moved within the patient's
abdomen, again to ensure that everything is done in a controlled manner to avoid
any damage.
The instruments that are used within the patient are inserted through normal
laparoscopic ports into the patient but they are attached to the
patient's side cart. This enables these instruments to have extra functions that
normal laparoscopic ones don't have. Normal laparoscopic instruments open
and close without any other range of movement, however, the robotic ones have a
articulating wrist. This enables the surgeon to work their way around bends
which is particularly important when you're trying to operate down in the
pelvis. Any patient with rectal cancer will require surgery within their pelvis.
The pelvis is a very challenging place to operate because it is a
confined space and carries important pelvic nerves have blood vessels. The
nerve supply, urinary and sexual function and the blood vessels drain not only the
pelvis but also supply the blood supply to the lower limbs. When operating on
rectal cancer, it is very important that not only do you remove the cancer but also the
lining of the bowel with it so as this reduces the risk of recurrence. It is
important that you perform a total rectal excision.
I believe that robotic surgery in colorectal cancer has many benefits to
the patient and the surgeon there are the benefits of reducing the risk of
converting to an open operation, you have precise operating, avoiding the risk
of damage to nerves and blood vessels. I also believe it offers the greatest
chance of removing the cancer in a safe way to reduce the risk of occurrence.