ADVANTAGES FOR PATIENTS

Minimally invasive robotic surgery allows your doctor better accuracy. The result for you? Shorter recovery time, better cancer outcomes, and:

• Low blood loss
• Bowel function returns more quickly
• Prompt return to diet
• Minimal time in the hospital
• Smaller incisions

COLON CANCER

Colon cancer (commonly referred to as colorectal cancer) is preventable and highly curable if detected in early stages. The colon is the first 4 to 5 feet of the large intestine. Colorectal cancer tumors grow in the colon’s inner lining. 

Surgery to remove the colorectal cancer is almost always required for a complete cure. The tumor and lymph nodes are removed, along with a small portion of normal colon on either side of the tumor. A colostomy is a surgically created opening that connects a part of the colon to the skin of the abdominal wall. This procedure is typically only done in a very small number of colorectal cancer patients.

Minimally invasive surgical techniques may be used by trained surgeons based on the individual case. Your surgeon will discuss this with you prior to surgery and decide on the most optimal approach. 

RECTAL CANCER

Rectal cancer arises from the lining of the rectum. Colorectal cancer is highly curable if detected in the early stages. For complete cure, surgery to remove the rectal cancer is almost always required.  Depending on the location and stage, this may be performed through the anus (opening of the rectum) or through the abdomen. Rectal cancer surgery removes the cancer and lymph nodes, along with a small portion of normal rectum on either side of the tumor. Creation of a colostomy (opening the intestine to a bag on the skin) is typically needed only in a very small number of patients. Trained surgeons may use minimally invasive surgical techniques depending on certain features of your cancer. Your surgeon will discuss these features with you prior to the operation. Additional treatment with chemotherapy or radiation therapy may be offered either before or after the surgery, depending on the stage of the cancer.

DIVERTICULAR DISEASE

Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon). There are two types:

• Diverticulosis: The presence of diverticula without associated complications or problems. The condition can lead to more serious issues including diverticulitis, perforation (the formation of holes), stricture (a narrowing of the colon that does not easily let stool pass), fistulas, and bleeding.
  

• Diverticulitis: An inflammatory condition of the colon thought to be caused by perforation of one of the sacs. Several secondary complications can result from a diverticulitis attack. When this occurs, it is called complicated diverticulitis.

Surgery for diverticular disease usually involves removal of the affected part of the colon. It may or may not involve a colostomy. A colostomy is when the end of the colon (large intestine) is brought through an opening (stoma) in the abdominal wall. A bag is attached to the outside of the patient’s belly to collect bowel movements. A decision regarding the type of operation is made on a case-by-case basis.

CROHN'S DISEASE

Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. Surgery is typically performed when the patient’s symptoms are no longer being controlled with their medications.  This usually means there is a section of bowel that is either too scarred or narrow to function properly.  The surgery can be performed either through a traditional open approach or a minimally invasive procedure. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. 

The most common procedure is removal of the last portion of the small bowel and the start of the large bowel to relieve abnormal, narrowed sections. Following removal of part of the bowel, the remaining bowel is reconnected if possible. The end of the bowel can also be brought through a surgical opening in the skin of the abdominal wall. This procedure (called an ostomy) redirects waste (feces) from the bowels.

ULCERATIVE COLITIS

Ulcerative colitis (UC) is an inflammatory disease potentially affecting the entire large bowel (colon and rectum). The inflammation is confined to the innermost layer of the intestinal wall (mucosa). Surgery is considered for patients when medical management is no longer effective. Other reasons that a patient may require surgery include cancer or precancerous lesions that are found during colonoscopy. Sometimes surgery needs to be performed when a complication of the disease occurs such as a perforated bowel (hole in the bowel), severe bleeding or serious infection (toxic colitis).

Since UC involves only the colon and rectum, complete removal of both may be done in some cases. This treatment option is curative, but requires an ileostomy. Some patients may be candidates for a J-pouch. This procedure involves the removal of the entire colon and all of the rectum with the exception of the last section where the sphincter muscles are located.  The small bowel is then used to create a “new” rectum (the pouch) which is attached just above the sphincter muscles. The patient will have a temporary ileostomy during the healing period however ultimately this will be taken down and the patient will be able to pass stool through their anus again.   

ANAL FISSURE

An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as hemorrhoids. Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscle relax which reduces pain and spasms, allowing the fissure to heal. 

FISTULA or ABSCESS

The treatment of an anal abscess is usually surgical drainage through a simple office procedure using local anesthetic. An incision is made in the skin near the anus to drain the infection. This procedure may also be done in the operating room under general anesthesia. 

Surgery is nearly always needed to treat an anal fistula. In many patients, if the fistula is not too deep, a fistulotomy is performed. During this surgery, the fistula track will be opened to allow healing from the bottom up. The surgery may require dividing a small portion of the sphincter muscle. More difficult cases may require multiple surgeries.