The Role of Robotics in Colorectal Surgery

Robotic surgery offers a minimally invasive alternative to both open and laparoscopic colorectal surgery. When we are talking about robotic surgery systems, we are talking about a computer-controlled robot that physician’s use to assist them in surgical procedures. In other words, a physician moves the robotic arms and hands, makes clinical decisions, and performs the procedure. We are not talking about artificial intelligence. A physician is controlling the operation at all times.

Robotic surgical systems are a step up from both traditional open surgery and minimally invasive laparoscopic procedures because physicians benefit from:

  1. Better visualization. Robotic surgery provides physicians with a high-resolution three-dimensional screen that provides greater visualization and depth perception of the surgical field.
  2. Enhanced dexterity. The robotic arm can mimic the way a wrist would move. You can rotate it 360 degrees and bend it back or forward. This is an improvement over laparoscopic instruments, which are straight like chop sticks with no degree of movement.
  3. Improved precision. Physicians can also precisely move the robotic arm and hand, and the movement is scalable. For instance, the physician can move an inch outside the body and program that movement to be one-third of an inch inside the body.

There are still skeptics who question the benefits of robotic surgery and whether it is a financially appropriate system for healthcare. Yes, the initial outlay and training for a robotic surgery system is expensive. However, that cost is at the hospital or health system level. There is no difference in cost for patients receiving a laparoscopic or robotic procedure. The cost for patients is the same. In addition, the cost per use is not that expensive. Once you have purchased the technology, it makes more sense to use it rather than to leave it sitting in the corner.

While robotic surgery systems may be expensive, there are numerous benefits to patients including, smaller incision sites, reduced scarring, less blood loss, faster recovery time, reduced pain, and shorter hospital stays. In addition, many colorectal operations are performed near nerves that control the bladder and sexual function of patients. Because robotic surgery systems provide better visualization and dexterity, there is less chance of injuring those nerves. This means that robotic surgery can reduce complications, which reduces length of stay, which reduces cost per case.

The question that the health industry must answer now is which procedures benefit the most from robotic surgery? Even though you can perform a gall bladder surgery with the robot, doesn’t mean you should—especially if there are no added benefits to the patient. The types of colorectal procedures where the robot will make a big impact is in difficult operations in the deep pelvis such as rectal cancers and resections for anal cancer. This is because it is difficult for surgeons to access these areas to remove tumors without performing an open surgery that involves a large incision and long difficult recovery for patients. There are also certain patient populations, such as obese patients or those with a narrow pelvis, who would benefit from robotic surgery. For colorectal surgery, the industry is still defining which procedures and patients would benefit most from robotic surgery, because it is still a relatively new technology for this specialty.

In the future, there is no question that robotic surgery will play an even larger role in reducing surgical complications and improving patient safety. The robot is already equipped to inject a temporary dye into the blood stream of patients undergoing bowel surgery, which enables the surgeon to see the blood flow to the anastomosis. This can help the physician reduce the likelihood of future leaks from the procedure, which is one of the main complications of bowel surgery. Soon there may be other markers that can help reduce complications from other colorectal procedures and further improve patient safety.