Rectal Cancer Surgery Using Surgical Assist Robot Started!
~ First in the Prefecture! Introduction of the latest da Vinci Xi system ~
In May 2022, Yamaguchi University Hospital (YUH) will begin “rectal cancer surgery using a surgical support robot (robot-assisted rectal resection and amputation surgery)” for rectal cancer. This robot-assisted surgery is a new endoscopic surgery. There have been methods until now such as open surgery and laparoscopic surgery but this has emerged as a new method. Surgical instruments and an endoscope are inserted through a small hole in the patient’s abdomen and are docked to a robotic arm, and the doctor operates forceps and camera while viewing endoscopic images in a remote operation box to perform the surgery. Compared to open surgery, laparoscopic surgery has the advantage of smaller surgical cuts and less damage (surgical invasion) to the patient, but the drawback was that the movement of forceps used was limited and the technique was more difficult. However, this robotic surgery, using forceps with a multi-joint function that exceeds the range of human joint movement while viewing 3D images from a camera with an image stabilization mechanism, can be said to more than compensate for the disadvantages of laparoscopic surgery while maintaining the advantages of minimally invasive laparoscopic surgery.
One of the most important points of rectal cancer surgery is to maintain a balance between cure (proper excision and removal of the cancer) and preservation of function (does not cause neuropathy). In the vicinity of rectal cancer to be removed, there are autonomic nerves to the bladder and anus. If too much emphasis is placed on proper removal of the cancer, this can damage the autonomic nervous system resulting in urinary, defecation, and sexual dysfunction. On the other hand, approaching a cancer lesion while attempting to avoid damage to the autonomic nervous system increases the risk of incomplete removal. Since robotic surgery is performed in an ultra-proximity surgical field using a 3D full high-definition camera, the autonomic nerve pathways are clearly defined, and compared to laparoscopic surgery, there is the potential for reducing neuropathy while improving the curative effect.
Robot-assisted surgery was introduced in 2012 at YUH, and the latest da Vinci Xi system (Intuitive Surgical Co.) is currently installed. It is implemented in urology (prosthesis, kidney), respiratory surgery (lung, mediase) and gastrointestinal surgery (esophageal / stomach). We have decided to start with rectal cancer this time, but this is the second installation in Yamaguchi Prefecture, and the first in the prefecture to introduce it with the latest da Vinci Xi system. With the introduction of this robot-assisted rectal cancer surgery, we will continue to provide an even higher standard of surgery that is gentle to the body and contribute to the improvement of rectal cancer treatment.
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This procedure was covered by insurance in 2018 and increasing explosively across the country. In order to carry this out, the procedure is required to be registered in a national clinical database, and a paper was published in September 2021 that looked back at this database and showed the results of this procedure. It showed that the procedure was superior to laparoscopic surgery in several respects (open abdominal transition rate, intraoperative blood loss, postoperative mortality rate, and postoperative hospital stay).