Enter the Surgical Robot: Colorectal Surgery

by Columbia Surgery on October 3, 2013

Colorectal Surgeon

Steven A. Lee-Kong, MD

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.”

For more information about colorectal diseases and their treatments, please visit the Division of Colorectal Surgery.

{ 6 comments… read them below or add one }

Dinah G. October 17, 2013 at 10:15 am

13 years after rectal cancer surgery, I still have rectal pain, mostly on the right side of the anus. I have been examined (including several colonoscopies over the years) and neither my surgeon nor my gastroenterologist can find fissures or other abnormalities. The pain is most severe after a bout of constipation. My pain medicine doctor at Weill Cornell administered 3 ganglion impar blocks, the last with ablation. The pain continues. He has prescribed Neurontin and Tramadol, the Tramadol being the only source of relief. It a medicine I do not wish to continue long-term. Any recommendations and/or advice would be more than appreciated.

Columbia Surgery October 17, 2013 at 10:29 am

Dinah,

Thank you for reaching out to us. I have forwarded your information to Dr. Lee-Kong, who would be best to address your question. As soon as I hear his response, I will reply.

You may always contact his office at: 212.342.1155. More information about Dr. Lee-Kong can be found on his profile at http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=sal116&DepAffil=Surgery

Columbia Surgery October 18, 2013 at 9:44 am

Hi Dinah,

I have received the following response from Dr. Lee-Kong:

I am sorry you have been suffering for this long. To try to address your concern: If you have been thoroughly examined by a colorectal surgeon and gastroenterologist without finding a fissure, I suspect your discomfort may be due to whats called “levator spasm” or anismus. It can present with pain during and after bowel movements or difficulty with bowel movements. This is caused by an abnormal tightening of the pelvic floor muscles. You may benefit from pelvic floor physical therapy. I would ask your surgeon or gastroenterologist for a recommendation to a facility close by your home. I hope this helps. Good Luck!

I hope this information is helpful. Please let us know if we can help further. Best regards.

Brett Prince October 23, 2013 at 4:47 pm

The precision provided by robotic procedures may help to shorten the exposure patients have to x-ray or anesthesia. This is good news for patients who are undergoing procedures that involve radiation such as angioplasties. The shorter the duration of the time spent on the operating table, the less exposure they have to the radiation.

Harry F. February 4, 2014 at 4:06 pm

A friend who is age 61 was found to have Stage 2A Colon cancer and underwent surgery to remove the entire large intestine. This took place in Houston, Texas and my friend is on public assistance. There was no discussion about laporoscopic or robotic surgery or anything short of open surgery removal of the large bowel. After reading about how this situation might be handled by Columbia University doctors I wonder if my friend was presented with the full range of options.

Columbia Surgery February 6, 2014 at 10:13 am

Hi Harry,

Unfortunately without an examination from our team, it is difficult to comment on your friend’s personal situation. We are hosting aColorectal Cancer Awareness Day if you would like to learn more information on risk factors, screening and early detection, treatment options. You may learn more about the event and register on our event’s homepage: Colorectal Cancer Awareness Day.

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