October 6, 2011

Robotic surgery now offered for colorectal cases

Robotic surgery now offered for colorectal cases

Paul E. Wise, M.D.

Paul E. Wise, M.D.

The robot will reduce recovery times, in comparison to open operations, while improving surgeons’ ability to make precise maneuvers and dissections in hard-to-reach spaces, according to Paul E. Wise, M.D., associate professor of Surgery and director of the Vanderbilt Hereditary Colorectal Cancer Registry.

VUMC has established itself as a leader in robotic surgery over the last eight years, with procedures ranging from prostatectomy to hysterectomy to gastric bypass.

The da Vinci Surgical System, manufactured by Intuitive Surgical, combines the benefits of minimally invasive laparoscopic surgery with the ease of “traditional” open surgery.

“I think where it will have the greatest advantage in colorectal operations is working in tight, narrow spaces like down in the pelvis,” Wise said.

“When I perform a laparoscopic rectal cancer operation, the needed exposure in the pelvis can be difficult to visualize. With the robot, we are able to get excellent visualization, and we are easily able to access hard-to-reach spaces in the pelvis and elsewhere. All the while I am able to use the benefits of the robot to perform the case more accurately.”

Vanderbilt colon and rectal surgeons average 70-80 rectal cancer procedures a year. Other procedures that can be performed using the robot include resections for inflammatory bowel disease, colorectal cancer/polyps, and rectal prolapse corrections, to name a few.

“VUMC beginning robotic rectal cancer operations is a natural evolution in the complexity of procedures that the Vanderbilt Colon and Rectal surgeons perform,” said Alan Herline, M.D., associate professor of Surgery and Biomedical Engineering and director of the Colon and Rectal Surgery Program. “Dr. Wise has done an excellent job of developing and learning these techniques that will benefit many patients.”

The state’s first robotic colorectal surgery was performed at Vanderbilt by Willie Melvin, M.D., a right colon resection for a benign polyp. Wise can claim the state’s first robotic operation on the rectum, in this case for rectal cancer.

Vanderbilt is the only place in the state doing any kind of rectal procedures or GI procedures with the robot, according to Wise.

“It gives us the ability to do some operations more accurately and safely,” he said. “The other thing is that the optics of the robot are amazing. It uses stereoscopic 3D, and the view and magnification are spectacular.”

“The view that we get is incredible, and that’s the same reason why urologists have been using it for years and gynecologists have been more recently using it at Vanderbilt. Similar to colorectal surgeons, these specialists are working in tight spaces. The robot allows for great magnification and the ability to work in those tight spaces a little bit more freely.”

Wise said the Vanderbilt team has been doing minimally invasive colorectal procedures for almost a decade and the robot has only come into play nationally within the last four to five years.

VUMC is now involved in a national, multi-institutional trial examining operative options for rectal cancer, comparing laparoscopic to open procedures for rectal cancer.

“I think, in general, the robot is a pretty intuitive instrument for surgeons to use – kind of like learning a video game to some degree,” Wise said. “Once you learn how to use the different mechanisms, it is pretty straightforward.”