The patient simply feels better afterwards. It makes a big difference. — Dr. Eric GirardAdvertisement
Traditional surgery and less invasive laparoscopic surgery still have limitations when it comes to access, visibility and precision. Robot-assisted surgery can overcome – and in many cases eliminate – those obstacles if dr. Eric Girard, explains a colorectal surgeon at UConn Health.
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Why is robotic surgery becoming more common?
If you’re looking for patients who want the fastest recovery time, the fastest return to work, and the least amount of discomfort, one of the most important things we can offer them is a safe, effective procedure. In many cases, we can reduce the patient’s stay to less than 24 hours, compared to three or four days with laparoscopic surgery or seven to 10 days with major open surgery, and the patient just feels better afterwards. It makes a big difference.
We do an intracorporeal anastomosis, essentially joining pieces of the intestine into the abdomen. It leads to reduced ileus (slowing down of the gut), reduced anastomotic leaks (a potential complication of gastrointestinal surgery), shorter length of stay, and better recovery. People are home sooner, back to work sooner and people are generally doing better.
To explain further, your bowel is probably in a fixed position. When we have to take out a segment, we have to move and manipulate the gut and loosen it from its attachments so that it then reaches the other part of the gut when we put it back together. That act of bringing the two ends back together is considered an anastomosis.
What are some other procedures for which robotics can make a big difference?
Colon cancer, rectal cancer, diverticulitis, inflammatory bowel disease, those are the big ones, for me at least. We can tackle everyone who has these problems robotic. We remove cancerous tissue, or in the case of diverticulitis, we remove a segment of the inflamed colon and reassemble it so that people don’t get recurrent infections that cause them a lot of pain, time in the hospital, and potentially holes in their gut that lead to stomas and need a bag.
If you have someone who has a lot of inflammation, whether it’s diverticulitis, people with fistulas, people with Crohn’s disease, that sort of thing, robotics can really make a big difference. When you have inflammation, the body tends to create this hard shell around whatever the source of that inflammation is. It makes it very difficult to find the right area between, say, two organs that are fused together. The robot helps me do that much better than laparoscopic surgery would. If you have a connection from the colon to the bladder laparoscopically, most people will have to open it and put a hand in it to feel that connection, while I can robotically manipulate the bladder. Instead of just having straight tools, I can go behind it with my wrist instruments and manipulate in ways that I can see that plane. And I have a third arm instead of just two hands.
What is it about the robotic approach that makes it beneficial?
I can see in 3D vision, I have the option to use a fluorescent dye that allows me to guarantee with 100% certainty that there is good blood flow to the area of my anastomosis. I have better visualization and I’m much more confident about what exactly I’m cutting when I’m cutting it.
If you have the robotic instrument, it is literally the same instrument that you would use in your hands, and whatever you have within reach, whatever surgical instrument your surgeon would use, it is exactly what the robot makes you do. So if I wanted a pair of scissors, I put the scissors in my tips and I can literally use them like they were my fingers, or I have a grapple and I’ll use them, and I can put them in any direction. It mimics my movements, and it eliminates any vibration and stabilizes the instruments. It can make your movements very fine, and if you have larger movements, they are basically reduced to very fine movements. And you have a significant zoom effect so you can really see up close.
How does robotic surgery fit into the concept of enhanced recovery after surgery (ERAS)?
It’s all part of getting patients back to normal faster and getting them back home faster. Improved recovery after surgery has a lot to do with not getting out of their daily pattern. We don’t let them starve; we let them eat as soon as possible. We try to get the patients up and walking right away. If they do everything they would otherwise do at home, then they can do it at home. We have people available 24/7; if they have problems, they can call and get help, but most people don’t. Once they’ve ticked all the boxes that they’re doing it right, they go home, and that means people can get back to their families faster.
We can do anything in the body, so that means there’s less tissue damage during the process of putting the gut together. The goal is to put everything back together in a way that continues to work, and with as little change as possible, as little interruption as possible to your normal life.
Who else does this?
Many other services use it in the same way, for example GYN for their endometriosis. Our gynecological oncologists use it. We have chest surgeons who take out parts of the lung with it. We have performed advanced hernia repairs on many of our general surgeons. Everyone adopts this advanced, minimally invasive approach because most people feel they give the patient a better chance of leaving the hospital earlier and recovering better.
Learn more about surgery at UConn Health., or call 860-679-8080 to arrange a consultation.
The post The ‘Big Difference’ of Robotic Surgery – UConn Today appeared first on Notesradar.
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