01 Mar 2010
When Mr Mervin Koh noticed specks of blood in his stools, he thought that eating too much spicy food might have been the cause. He stayed away from his favourite spice, but his condition did not improve. He decided to consult a colorectal specialist who told him he had rectal cancer.
“I was shocked and saddened, but I refused to panic. The doctor had recommended immediate surgery, then chemotherapy, but I wanted a second opinion,” said Mr Koh. He saw Professor Eu Kong Weng, Head and Senior Consultant, Department of Colorectal Surgery, Singapore General Hospital (SGH), who delivered the same diagnosis, and proposed a surgical procedure known as robot-assisted laparoscopy. Said Mr Koh, 44: “The technique is relatively new, but it didn’t worry me, especially since Prof Eu was very confident of its results. I had the procedure done in the same week as my first consultation with him.”
Man behind machine
During the operation, Prof Eu made three small incisions (each about 1cm long) to mobilise, or isolate, the colon and a 3-4cm incision to remove a length of rectum. The surgery took 21/2 hours, following which Mr Koh spent two days in the high dependency unit, where he was “pleasantly surprised that [he] felt no pain or physical discomfort.”
Now fully recovered, he only has small scars on his lower abdomen, which he describes as “fine lines” as the sole reminder of his experience.
Mr Koh is one of at least 35 patients to have undergone robot-assisted surgery for colorectal cancer since SGH’s Department of Colorectal Surgery introduced the ultraprecise and intricate procedure in late 2007.
The procedure requires the use of a machine known as the da Vinci Surgical System, which SGH bought in 2003 for laparoscopic surgeries on prostate cancer patients at its Urology Centre. However, Prof Eu recognised the many benefits of robot-assisted laparoscopic surgery, and proposed using the machine in colorectal surgery.
In laparoscopic or keyhole surgery, much smaller incisions – about 1-4cm versus 10-15cm in conventional surgery – are made, and using robots like the da Vinci in such procedures takes surgical techniques to a new level.
The da Vinci comes with four robotic arms, which hold special miniaturised surgical instruments and a laparoscope, a tiny, flexible tube with a small, highdefinition 3D camera. Seated at a nearby console, the surgeon views a magnified image of the surgical site and manipulates the robotic arms to perform surgery. The machine’s features make it particularly suitable for operating on delicate areas such as the rectum, where precision is crucial, said Prof Eu. Using the machine, the surgeon is able to operate with greater dexterity, precision and control. “It’s as if I’m putting my hands in the patient’s abdomen,” he said.
For the patient, such surgeries usually mean less pain, blood loss and scarring.
Infections are kept to a minimum because of the smaller incisions, so patients can expect a shorter hospital stay and faster recovery period.
Increased efficiency
Prof Eu expects surgeons to become more efficient as the use of robot-assisted laparoscopy becomes more widespread. Robot assisted surgery typically takes about 45 minutes, significantly longer than conventional operations, as time is needed to position and park the robot. Apart from setting up the equipment, the surgeon usually needs just one other assistant surgeon.
Said Prof Eu: “I used to need up to four assistants – all of whom had to be trained for a single surgery. But the da Vinci Surgical System is almost like a one-man-operation, because the surgeon can complete the surgery with just a few controls.” He added that because the procedure is now simpler, it is also easier to teach more surgeons to perform colorectal surgery.
While robot-assisted laparoscopy costs about $3,000 more than conventional laparoscopy, Prof Eu is hopeful that increased demand, improved technology and greater market competition will help push prices down, eventually making it the procedure of choice for all patients.
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