A colectomy is a surgery to remove all or part of the large intestine. Colectomy is also referred to as "colon resection." It is done to treat serious colorectal conditions such as colorectal cancer, diverticulitis and blockages caused by scar tissue.
Colorectal surgeons at Swedish – who have vast experience in laparoscopic colectomy – are now at the forefront of performing robotic colectomy.
In the videos below, Dr. Amir Bastawrous describes the robotic colectomy procedure and its benefits.
The large intestine includes the colon, the rectum and anus. During a colectomy, the diseased or damaged section of the intestine is removed and the healthy sections are attached.
Options for performing this surgery include:
- Conventional "open" colectomy: involving a large incision down the abdomen
- Laparoscopic colectomy: using a scope and rigid, long-handled instruments to operate through small incisions
- Robotic colectomy: the latest laparoscopic advancement using flexible instruments and an improved system for viewing the surgical area.
Since about 2005, the daVinci robotic system has been used in the U.S. to treat a variety of conditions. Its use for treating colorectal diseases, however, is very recent. As a result, few surgeons in the country have the experience to do robotic colorectal procedures.
At Swedish, robotic colectomy is done primarily for patients who need part or all of their rectum and/or anus removed.
All robotic procedures are done in an operating room, with a specially trained surgical staff. Patients are under general anesthesia, and constantly monitored by an anesthesiologist.
To begin the procedure:
- The surgeon makes 4 – 6 small incisions in the abdomen
- The abdomen is inflated with carbon dioxide to give the surgeon room to work
- Specially designed surgical instruments and a tiny camera are attached to robotic arms and precisely inserted through the incisions
- The surgeon then sits at a nearby console, controlling every movement of the robot arms
If the colectomy is done in the colon, the surgeon:
- Cuts the colon on either side of the diseased segment
- Removes the segment through one of the incisions
- Inserts a seal and sutures the two new ends together
If the colectomy is done in the colon, the surgeon:
- Carefully resects (or frees) the rectum from where it is attached
- Ties off the blood supply
- Divides the rectum to separate the part that needs to be removed
- Removes the selected section
- Puts everything back together
Once the procedure is complete, the camera and surgical instruments are removed and the abdominal incisions sutured closed. If a colostomy is needed, it is created at one of the incisions sites.
With open colectomy, the body must heal from the large incision in the abdomen that cuts through tissue and muscle.
If you are having open surgery, you will be in the hospital for four to five days. In five to eight weeks, you'll be able to return to some of your normal activities.
In comparison, people who have a robotic colectomy:
- Stay in the hospital three to four days
- Are often back to work in two weeks
- Experience much less pain
Laparoscopic rectal colectomy is particularly challenging. The rectum is contained in the pelvis and difficult to access. Also, the surgery is viewed on a 2-D flat screen.
In comparison, robotic surgery gives the surgeon:
- Flexible surgical instruments that mimic the movements of the surgeon's wrist
- A 3-D field of view at the console
- The field of view is also magnified to give the surgeon a close look
A better experience for the surgeon often means a better outcome for the patient, including less chance of complications.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
The overall complication rate for colectomies is very low.
With any open procedure, there is an increased risk of post-surgery infection, breakthrough bleeding and blood clots. With an open procedure, the seal at the new connection point of the intestine fails in one to three percent of cases.
With laparoscopic colectomy, there is in increased of damaging the nerves that effect the bladder, and – in men – the nerves that affect sexual function.
With robotic colectomy, complications are uncommon.
Swedish has the largest group of colorectal surgeons in the region, and one of the largest in the West. They are experienced in all surgical methods, and train surgeons from around the country in colorectal surgery techniques.
Now, they are on the leading edge of colorectal robotic surgery. In the Seattle area, they are the only ones doing these procedures on a regular basis.
When interviewing a surgeon for a robotic surgery, you may want to ask:
- How long robotic surgery has been available at the hospital?
- Does it have a surgical suite dedicated for robotic surgery?
- How many robotic surgeries are performed there?
- How long has the surgeon been doing robotic colectomies?
Swedish is committed to developing procedures that provide better outcomes for our patients. We are a regional center for performing – and teaching – robotic surgery.
More than 4,000 robotic procedures have been performed here and everyone on our robotic surgery teams is specially trained and highly experienced.