Advances in Surgical Management of Colorectal Diseases

Submitted by Kristin Turza, MD, FACS, Augusta Health Surgery

Colon and rectal ailments, including diverticulitis, rectal prolapse, and colorectal cancer, often require operative intervention. According to the American Cancer Society, lifetime risk of developing colorectal cancer in the U.S. is 1 in 20.1 Fortunately, the death rate from colorectal malignancy has been dropping thanks to screening with colonoscopy and improved medical treatments and surgical options. Surgery is often the main definitive treatment for earlier-stage cancers and frequently required for palliation in more advanced ones as well.

The surgeon considers many factors when selecting the appropriate operation for a colorectal ailment and a suitable technique (robotic, laparoscopic etc) through which to accomplish it. These factors are patient and disease specific, and examples include patient co-morbidities, goals of care, and the location and extent of cancer.

While laparoscopy certainly has many benefits to patients undergoing colorectal operations and is routinely used, robotic surgery has added a new facet to minimally invasive surgical options. The robotic platform, now at Augusta Health, is used in a range of operations in colon and rectal surgery. Robotics is uniquely suited to several colorectal operations, including colon and rectal cancer surgery, rectopexy for rectal prolapse, complex diverticulitis, and transanal surgery.

The excellent visualization with the robotic camera in the deep, narrow pelvis, as well as precise dissection that is possible with robotic instrumentation certainly can optimize outcomes. Precision in a rectal dissection for malignancy (also known as a ‘total meosrectal excision’ (TME)) is critical in achieving a negative resection margin, which has obvious oncologic implications. The wristed instruments used in robotics allows ease of suturing, such as would be required for rectopexy. These unique instruments are also beneficial when dissecting in narrow anatomic regions, such as is done with transanal excision of rectal polyps. If an anastomosis is being made, robotics can facilitate creating an intracorporeal anastomosis, which means that the entire surgery is completed inside the body, including putting the bowel together, resulting in a completely minimally invasive operation.

The future of technology in colorectal surgery is constantly evolving. We will continue to strive to be on the forefront of developments and bring its benefits to our community.

1 “Colorectal Cancer Facts and Figures.”