February 2024Spotlight feature

Robotic colorectal surgery launched at the JGH

New technology improves accuracy, shortens operations, reduces strain on surgeons

Colorectal Surgery has become the latest surgical division at the JGH to use a robot to assist in performing certain minimally invasive procedures with greater ease, accuracy and speed.

“We’re very excited about this milestone, because we’ve all worked so hard to get here,” says Dr. Carol-Ann Vasilevsky, Chief of Colorectal Surgery, referring to the JGH’s first robotic colorectal operation on January 18.

Before performing robot-assisted colorectal surgery, Dr. Allison Pang guides one of the robotic arms into position. The narrow rod that has been inserted into the patient’s abdomen will serve as a pathway for tiny surgical instruments that Dr. Pang will manipulate remotely. (Click on this or any photo to enlarge it.)

Before performing robot-assisted colorectal surgery, Dr. Allison Pang guides one of the robotic arms into position. The narrow rod that has been inserted into the patient’s abdomen will serve as a pathway for tiny surgical instruments that Dr. Pang will manipulate remotely. (Click on this or any photo to enlarge it.)

“It’s been a long time coming,” agrees Dr. Allison Pang, the surgeon who performed the first procedure. “Naturally, along with the excitement, there’s a learning curve in getting used to the new technology. But everything has gone smoothly and the teamwork has been great.”

Like surgical robots in most other specialties, the mechanism in Colorectal Surgery consists of two large, connected components: a console and a four-armed device that is suspended over the operating table and the patient.

During the operation, the surgeon does not stand next to the patient, but sits at the console three or four metres away. While looking through a viewfinder at a specific area inside the patient’s body, the surgeon manipulates the console’s hand and foot controls, causing the robotic arms to respond.

Three of the arms have small surgical instruments at their tips, which are directed toward the desired location in the patient’s body. A fibre-optic camera on the fourth arm relays three-dimensional images to the console’s viewfinder and to large screens in the operating room.

Since the robotic instruments can make movements that are tinier and more precise than what a human hand is capable of, and since these instruments can be positioned at angles that a human hand cannot match, robotic surgery generally achieves better results than conventional surgery or even minimally invasive laparoscopic surgery.

Dr. Allison Pang at the console where she performs robot-assisted colorectal surgery.

Dr. Allison Pang at the console where she performs robot-assisted colorectal surgery.

“We’re looking forward to seeing a reduction in the length of patients’ stay in the hospital,” says Dr. Vasilevsky. “Until now, that’s been three or four days, depending on the type of surgery,”

She adds that patients who undergo robotic colorectal surgery are also likely to recover more quickly and with less discomfort than those who have had conventional open surgery (where an incision is made and surgery is performed by reaching into the opening). This is because robotic surgery requires less manipulation of the bowel and can be performed with smaller incisions.

Another benefit, Dr. Vasilevsky says, is that the 3D image in the console’s viewfinder is far superior to the  flat, two-dimensional image produced by the camera for laparoscopic surgery.

“For instance,” she explains, “when you’re using the robot for pelvic surgery—say, for cancer of the rectum—you have much better visualization of the pelvic nerves. This allows you to spare them more effectively than if you performed the procedure laparoscopically. Your visualization of all of the anatomical structures is much better.”

Despite the advantages of laparoscopic surgery over open surgery, laparoscopy has drawbacks of its own for surgeons, says Dr. Pang. Chief among these is that the surgeons must continuously grasp and manipulate the rods whose tips hold the tiny surgical instruments. This often causes considerable strain to wrists, arms, elbows and shoulders.

“With the robot, the ergonomics are much better,” she says. “You’re seated at the console while the robotic arms hold the instruments. You can take your time and concentrate, without having to worry about sore muscles.”

Among the members of the JGH colorectal surgery team are (from left) Raina Odegard, Licenced Practical Nurse; Sonya Brin, Nursing Team Leader and Coordinator of Robotic Surgery; Dr. Carol-Ann Vasilevsky, Chief of the Division of Colorectal Surgery; Dr. Allison Pang, Colorectal Surgeon; and Adrienne Wheeler, Nursing Team Lead for General Surgery.

Among the members of the JGH colorectal surgery team are (from left) Raina Odegard, Licenced Practical Nurse; Sonya Brin, Nursing Team Leader and Coordinator of Robotic Surgery; Dr. Carol-Ann Vasilevsky, Chief of the Division of Colorectal Surgery; Dr. Allison Pang, Colorectal Surgeon; and Adrienne Wheeler, Nursing Team Lead for General Surgery.

Key support in the launch of robotic colorectal surgery was provided by grateful patients, whose donations enabled the JGH to purchase a special tilting operating table, Dr. Vasilevsky says.

In many types of robotic surgery, the table remains in a fixed position, because the focus is on a single organ, she explains. However, in colorectal surgery, work is often performed in several winding, hard-to-reach areas, such as the seven metres of small bowel.

Normally, the robot would have to be repositioned (known as redocking) for each change in location. However, since the new table can tilt and swivel at various angles, there is no longer any need to redock, thereby reducing the length of the surgery.

Dr. Vasilevsky adds that such a successful launch would not have been possible without the tightly coordinated preparation by staff. In fact, she notes, a proctor from the United States who inspected the robot before it went into service said she had never previously seen a comparable degree of collaboration among members of staff.

“In addition to all of the robot’s advantages, the arrival this type of surgery means we’re keeping pace with advances in technology,” says Dr. Vasilevsky. “By expanding the use of robotics in our hospital, we’re helping to open the door even wider in performing more types of surgeries more effectively and with greater accuracy.”

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