High technology in our culture has raised many eyebrows recently, with ongoing public controversies about the appropriate use of surveillance, drones, and more. But the presence of robots in our operating rooms is one advance that we might be glad to approve. We talked with Steven Lee-Kong, MD, Assistant Professor of Clinical Surgery in the Division of Colorectal Surgery, about his use of the surgical robot during colorectal surgery.
During robotic surgery, the surgeon sits at a console which includes a large, high definition computer screen and controls to manipulate the surgical instrumentation. Across the room at the operating table, narrow arms with tiny surgical tools and a miniature camera are inserted through two to four tiny incisions (8 to 12 mm each) in the patient’s abdomen. Sitting at the console, the surgeon has an excellent magnified view and can move the instrumentation to carefully perform each step of the operation.
According to Dr. Lee-Kong, who has been using this technology at NewYork-Presbyterian/Columbia since 2012, the surgical robot offers significant advantages during many colorectal operations. One of the most important advantages is that the quality of imaging is much better than that during traditional laparoscopy. “It is truly three-dimensional visualization. During pelvic and rectal operations, it is quite evident that the view of critical structures is better,” says Dr. Lee-Kong. “We can see the nerves for sexual function and urinary function far better, and I think we can preserve these nerves better because of that view.” Although it has not yet been proven whether the nerves are better preserved during robotic surgery than laparoscopy, this question is currently under study.
Another advantage is that the robotic instrumentation is ‘wristed,’ meaning that it mimics the motions of the human hand. Even better than a human hand, it allows more degrees of freedom and improved dexterity in tight spaces.
Dr. Lee-Kong now performs slightly over half of abdominal operations robotically, as well as many colorectal procedures including:
- Colectomies (removal of large parts of the intestine)
- Rectal resections for rectal cancer
- Rectopexy (surgery to correct rectal prolapse)
- Removal of benign polyps of the colon that can not be removed during colonoscopy
“We offer minimally invasive surgical options because we know, based on data for laparoscopic surgery, that patients will have shorter hospital stays, will need less narcotic pain medication, and will return to normal activities faster than after open surgery. Robotic surgery offers all the benefits of laparoscopic surgery, but can allow us to do more fine dissection, more complicated work that can not always be done laparoscopically.”