Robotic Surgery | City of Hope

Robotic surgery revolutionizing colon cancer treatment

“When a patient hears the “c” word, it usually triggers acute anxiety — and when it’s colon cancer , the fears they spontaneously express are: Am I going to die? Will I have to have a permanent colostomy? said Andreas M. Kaiser, M.D., chief of colorectal surgery at City of Hope. “But the truth is, you have a good chance of beating the disease and avoiding a permanent colostomy,” he added.
Kaiser is a renowned expert in an advanced technology that’s making a huge impact on patient experience, recovery time and outcomes — robotic surgery.

The Advantages of Robotic Surgery

To someone watching robotic surgery for the first time, it might seem like a scene from a futuristic film. At the patient’s bedside stands a sleek robot, whose four slender arms wield surgical tools and a 3D camera. Nearby, a human surgeon, seated at a pod-like console, controls the robot’s every movement.  
“The console is like a cockpit,” said Kaiser. “We have little handles and pedals that we can use to control the robot.”
Andreas Kaiser
Andreas M. Kaiser, M.D.
The advantages of machine over man are impressive. The three-dimensional camera provides remarkable visual clarity. The robotic arms can enter very narrow spaces, and are so flexible they can turn in almost any direction to perform highly precise surgery. The incisions are tiny — 8 mm for each of the instruments and the camera, and 12 mm (less than half an inch) for a device to cut and staple the bowel. Often, the colon can be reconnected without an additional abdominal incision.
To retrieve the cancerous part of the colon that has been resected, a transverse incision of roughly 1.5 to 2 inches is sufficient. The incision is made in the very low abdomen, so it’s not only much smaller than the large vertical cut of conventional open surgery, it’s also more cosmetically appealing.
While it’s not always the right choice for every patient, robotic surgery has several major advantages over other types of colorectal cancer surgery.
Traditional open surgery requires an abdominal incision roughly 6 to 20 inches long — large enough for the surgeon to insert his hands, feel around for the tumor, then excise and remove a section of the colon.
“It’s not a bad operation,” Kaiser said, “but the intestines don’t really like us in there. They always get a little bit ‘offended,’ I like to call it. Then they don’t want to work anymore, and it takes some time for them to wake up again.”
What’s more, the larger the incision, the more postsurgery pain it can cause for the patient. The hospital stay and recovery times are much longer than with less invasive techniques, and there’s also a higher risk that a hernia may form in the future.   
The first alternative to open surgery was laparoscopy, and it has been used for colorectal resections since the 1990s. With this technology, as with open surgery, the surgeon stands at the patient’s bedside, but the laparoscope replaces the human hand. Like the robot, it makes very small incisions, then locates and removes the cancer. However, unlike robotic surgery, the camera images are often only two-dimensional, and the laparoscope has a limited range of motion, so it is more difficult to operate in small spaces.

Some Fears Allayed

The biggest fear, of course, is survival. And if colon cancer is discovered while it is still localized and no lymph nodes are involved, surgery alone is usually the only treatment needed, with a five-year survival rate of 90%. When the cancer has spread to nearby lymph nodes and organs, the survival rate drops to 71%.
That’s why it’s so important to overcome the fear of a colonoscopy. This type of screening not only detects early-stage cancer, it can also prevent the disease by removing precancerous polyps during the procedure.
Another big fear for colorectal cancer patients is that they’ll permanently need a colostomy bag.
“That fear is not usually true,” said Kaiser. “As long as some healthy tissue remains below the tumor, we can keep the sphincter muscles in place and do a reconstruction.”

Choosing the Right Medical Team

“Every surgery has risks, but if you go to a center that’s experienced, those risks will be much lower,” said Kaiser. “Numerous studies have shown that centers with higher levels of expertise and routine tend to have better outcomes. So what you want is somebody who has a track record of performing colon surgeries on a regular basis — not just once a month or so.”
Another key to successful treatment is the medical team the surgeon is part of — and that’s what attracted Kaiser to City of Hope. He joined the team here on Jan. 1, 2020, after 20 years at Keck School of Medicine of USC, where he was a professor of clinical surgery and, for a period of time, the interim chairman of the Department of Colorectal Surgery.
“City of Hope has a comprehensive approach that allows the patient to be seen through many different eyes,” he said. “Each patient has several specialists, with access to the latest treatments and technologies, who analyze their genetics and weigh their risks.”
He also stressed one more important factor when it comes to beating cancer.
“Even when cancer has spread, not all is lost. Not at all. Everyone who has cancer should have their options assessed by experts,” he said. “Patients confronted with colorectal cancer should also look at their own willingness to push through and fight as hard as they can. The road is not always easy. But if a patient and the family are willing to accept the challenges of fighting, we are here to help and to give hope.”