Maximum Precision for Minimal Post-Surgical Pain

Dr Dean Koh
Senior Consultant General and Colorectal Surgeon
Colorectal Clinic Associates

Published in, Issue 6, 2022

Maximum Precision for Minimal Post-Surgical Pain

Colorectal cancer is currently the third most common cancer globally. According to World Cancer Research Fund International, over 1.9 million cases of colorectal cancer were recorded in 2020, with up to 600,000 deaths annually. While studies show that early screening can reduce the mortality rate, it is also crucial for the healthcare sector to devise less invasive medical interventions to minimise post-operative complications and improve patient recovery.

One such method is robotic surgery, a minimally invasive surgical procedure that has refined laparoscopic techniques and can treat many types of colorectal cancer with smaller incisions compared to traditional open surgery. Smaller post-operative wound size leads to less pain, lower risks of infection while preventing pulmonary and long-term complications such as incisional hernias. This, in turn, reduces the need for pain medications and their side effects. Moreover, this procedure allows patients to recover faster, with brief hospitalisations and swift returns to daily routine.

According to Dr Dean Koh who specialises in colorectal surgery and surgical oncology at Mount Elizabeth Novena and Parkway East Hospital Singapore, robotic surgery is suited for colorectal cancer due to the system's accuracy in navigating through the confined spaces of the lower abdomen and pelvis, which are packed with several organs and vital structures, reducing the likelihood of adverse complications.

Impact of minimally invasive procedures on post-operative recovery

Hospital stays for patients recovering from conventional open surgery range from seven to 10 days on average. However, laparoscopic surgeries have reduced the duration of hospital stays to three/five days, as multiple studies have demonstrated. Shorter hospital admission minimises the risk of conditions associated with prolonged bed rest, such as deep vein thrombosis, lung infections, urinary tract infections, and post-operative deconditioning. Reduced pain enables patients to walk around even during the early days post-surgery.

Robotic instruments

Recent years saw the tremendous development of modern robotic systems designed to undertake conventional laparoscopic techniques. These latest systems have given surgeons improved tools to perform resections for colorectal cancers in every segment of the colon and rectum, according to Dr Koh who has practised robotic surgery since 2008. This is due to new designs of the patient side cart and the robotic instruments, which have improved dexterity and motion range. He added that this feature allows the robotic system to be easily manoeuvrable with little external collisions of the arms during surgery.

While Dr Koh assures that experienced surgeons can successfully use robotic tools for all colorectal cancers that can be treated with laparoscopic surgery, there are exceptional circumstances where both minimally-invasive approaches are inapplicable. One example is the case of a large colorectal tumour that has spread to other surrounding organs, leading to serious health problems like bowel obstruction.

Robotic system components outperform standard laparoscopy

Research shows that patients who undergo minimally invasive procedures have lower levels of blood markers such as C-reactive protein (CRP) and interleukin (IL), indicating they experienced reduction in surgically induced trauma compared to patients treated with conventional surgery. And robotic procedures can outperform standard laparoscopy because they provide improved optical vision, accuracy and optimal magnification of the internal tissues.

The standard robotic system comprises an optical camera system and three operating arms, which a single user can handle. The optical cameral system comprises of a dual-lens device with multiple imaging features such as high-definition image quality, 3D visualisation and 10X magnification power.Furthermore, mechanical aspects such as motion scaling and tremor dampening provide an operating tool that is more stable than human wrists while conducting surgery.

Robotic surgery has also been demonstrated to significantly reduce surgeon fatigue. Unlike open surgery and standard laparoscopy where surgeons are constantly holding surgical tools and stand for long hours throughout the procedure, robotic surgery allows them to be comfortably seated at the console cart while operating robotic arms that emulate surgeon hand movements but with enhanced dexterity and precise micro-movements in conducting incisions, Dr Koh explained. For example, a recent pilot study determined that primary surgeons who practised robotic surgery displayed less hand and torso muscle fatigue compared to those conducting laparoscopy.

The seamless function of all robotic system components simultaneously translates into a more precise and accurate surgical work and enhanced safety due to a lower risk of damaging organs during resection. This means that robotic surgery is always preferable to standard laparoscopy for surgeons who are well versed in using robotic instruments.

Treatment outcomes of robotic surgery

In general, robotic surgery and laparoscopy lead to comparable disease-free survival and recurrence rates in colorectal cancer patients treated by experienced surgeons. Various studies have demonstrated that both approaches produce excellent disease management results and a favorable disease-free survival rate, especially in the early stages of cancer. It is essential to acknowledge that these comparative studies between open surgery, laparoscopy, and robotic surgery have shown that the three surgical approaches are similar in terms of treatment outcomes. But they have also proved that minimally invasive procedures benefit patients by improving recovery and minimising the risk of perioperative complications for patients without affecting their chances of survival.

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