Colorectal & Oncology

Colon Resection

Each year, more than 600,000 surgical procedures are performed in the United States to treat a number of colon diseases.

What is the colon?

The colon is the large intestine, the lower part of your digestive tract. After food is swallowed it begins to be digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste moves through the colon to the rectum and is expelled. The colon and rectum absorb water and hold the waste until you are ready to expel it.

What is robotic colon resection?

Minimally invasive robotic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery. In most robotic colon resections we operate through four or five small openings, each about a quarter inch, while watching an enlarged image of your internal organs on a monitor. In some cases one of the openings may be lengthened to two or three inches to complete the procedure.

Advantages

• Less postoperative pain
• May shorten the hospital stay
• May result in a faster return to a solid-food diet
• May result in a quicker return of bowel function
• Quicker return to normal activity
• Improved cosmetic results

Although robotic colon resection has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in robotic colon resection, in consultation with your primary care physician, to find out whether the technique is appropriate for you.

Recovery

After the operation it is important to follow your doctor's instructions. Although many people feel better in a few days, remember that your body needs time to heal. You are encouraged to be out of bed and walking the day after surgery — this helps diminish soreness in your muscles. You will probably be able to get back to most of your normal activities in one to two weeks, including showering, driving, walking up stairs and working. Call and schedule a follow-up appointment within two weeks after your operation.

Colon & Rectal Cancer Surgery

Surgery is one of the primary treatments for colon cancer, especially during its early stages. We use many surgical approaches, including advanced minimally invasive techniques that reduce recovery time.

What is colon cancer?

Colon cancer begins in the large intestine. It usually starts out as a noncancerous polyp; left untreated, these polyps turn cancerous and grow into tumors. Colon cancer is common, and treatable when found early.

Rectal cancer is not the same as colon cancer. “Colorectal cancer” describes both. Rectal cancer starts in the rectum, and surgery for it is more complex because of the size of the rectum and where it sits.

Kinds of colon cancer surgery

For colon cancer surgery we perform a colectomy — the surgical removal of some or all of the colon.

Partial colectomy

The surgeons remove the cancerous area of your colon, plus a small section above and below the tumor.

Total colectomy

A total colectomy is the complete removal of the colon. We rarely need to do a total colectomy for colon cancer surgery.

The kind of surgery you need for rectal cancer depends on how big the cancer is and where it is. Surgery could require partial or total removal of the rectum. If the rectal cancer is near the anus, the surgeons may remove both the anus and the rectum.

How it's done

Traditional open surgery

Your surgeon makes a single large incision through your abdomen to gain access to your colon or rectum and remove the cancerous tissue.

Robotic surgery

The surgeons use minimally invasive tools and techniques to access and remove the cancer. With robotic surgery we operate through four to five small incisions while watching an enlarged image of your internal organs on a computer screen.

What to expect

You can expect a faster recovery, less pain after surgery, and less scarring following robotic surgery. However, the advanced minimally invasive technique is not the best approach for all patients. We create an individual plan for each patient and use the tools and techniques that provide the safest and most effective outcome.

Robotic Gastrectomy (Stomach Cancer)

If your doctor recommends a gastrectomy to treat stomach cancer, you may be a candidate for a safe, effective and minimally invasive robotic gastrectomy via the da Vinci surgical system.

Using the most advanced technology available, the da Vinci System enables your surgeon to perform this delicate operation through a few tiny incisions with vision, precision and control that overcome the limits of both traditional open and laparoscopic surgery.

Potential benefits

• Low risk of complications
• The ability to operate minimally invasively even on advanced cancer

Stomach cancer is the second most deadly cancer worldwide. If you have been given this diagnosis, a consultation about surgical options is worth having early — call us and we will make room.

Robotic Pancreatic Surgery

If your doctor recommends surgery to treat a disease affecting your pancreas — such as chronic pancreatitis or pancreatic cancer — you may be a candidate for minimally invasive robotic pancreatic surgery via the da Vinci surgical system.

The da Vinci System enables your surgeon to perform this delicate operation through a few tiny incisions with breakthrough vision, precision and control.

Potential benefits

• Reduced surgical trauma
• Excellent cancer control, where indicated
• Minimal blood loss
• Fast recovery

Spleen Removal (Splenectomy)

The spleen is a blood-filled organ in the upper left abdominal cavity. It stores red blood cells and contains specialized white blood cells called macrophages, which filter blood and help the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.

Why a spleen might need to be removed

There are several reasons, and this list is not exhaustive:

• Idiopathic thrombocytopenic purpura (ITP) — the most common reason. Platelets are blood cells that aid clotting.
• Hemolytic anemia, where removal prevents or decreases the need for transfusion
• Hereditary conditions affecting the shape of red blood cells — spherocytosis, sickle cell disease, thalassemia
• Lymphoma and certain leukemias
• An enlarged spleen removing too many platelets from your blood
• Tumors, to diagnose or to treat
• A blocked blood supply (infarct) or an aneurysm of the splenic artery

An evaluation typically includes a complete blood count, a visual look at the blood cells on a glass slide (a “smear”), and often a bone marrow examination. Sometimes an ultrasound, CT scan, MRI or nuclear scan is needed.

How the operation is performed

You will be placed under general anesthesia. A cannula is placed into the abdomen and your abdomen is inflated with carbon dioxide gas to create space to operate. A laparoscope connected to a video camera projects a picture of the internal organs and spleen onto a monitor. Several cannulas are placed in different locations to allow instruments to work and remove the spleen. A search is made for accessory (additional) spleens, which about 15% of people have, and these are removed as well. Once the spleen is detached it is placed inside a special bag, drawn up into the largest of the small incisions, broken into small pieces within the bag, and completely removed.

Advantages and recovery

• Less postoperative pain
• Shorter hospital stay
• Faster return to a regular, solid-food diet
• Quicker return to normal activities and better cosmetic results

After surgery you will be given intravenous fluids. You may have a tube through your nose to prevent vomiting or stomach bleeding, since the stomach can fill with juices and not empty properly after this surgery; not every surgeon uses this tube. You will be given pain medication — let your nurse and surgeon know what your needs are, since everyone has a different pain threshold. As soon as you can resume oral intake, urinate and care for your basic needs, you will typically be able to go home.

At home

Each situation differs, so discuss activities with your doctor. Generally: you can walk and go up stairs, and you can shower, though most surgeons prefer you not soak in a tub for at least a week. Most people can resume driving five to seven days after surgery, and you should not be taking pain medication when you drive. Unless you have special dietary needs you can eat a normal diet. It is common to become constipated after surgery, especially while taking pain medication — drink plenty of water and take in enough fiber, and ask us before taking anything for it.