Our Summary

This study at the Mayo Clinic in Minnesota, USA, looked at the outcomes of two types of minimally invasive surgery for certain digestive diseases - robotic proctectomy and laparoscopic proctectomy. Both these surgical procedures involve the removal of the rectum and creation of a pouch from the small intestine to act as a new rectum (IPAA). This is a common treatment for conditions like ulcerative colitis and familial adenomatous polyposis.

The study found that the robotic procedure took longer than the laparoscopic one (around 263 minutes compared to 228 minutes). However, the robotic surgery had some advantages: patients undergoing robotic surgery lost less blood during the operation and none of them needed to switch to open surgery (conversion rate). Also, the robotic surgery group received more fluids during the operation.

There was no difference between the two groups in terms of the length of their hospital stay, complications within 30 days of surgery, the need for readmission or further surgery within 30 days, and the rate of closure of the temporary opening in the abdomen (ileostomy) at three months.

The authors cautioned that the study’s design and its focus on one particular medical center might limit the applicability of the results. They also noted that they have not yet researched long-term outcomes and quality-of-life issues. More research is needed to fully understand the pros and cons of robotic surgery for these conditions.

FAQs

  1. What are the two types of minimally invasive surgery for digestive diseases studied at the Mayo Clinic?
  2. What are the advantages of robotic proctectomy over laparoscopic proctectomy as found in the study?
  3. What are the limitations of the study on robotic and laparoscopic proctectomy conducted at the Mayo Clinic?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss with them the potential benefits and risks of both robotic and laparoscopic surgery options. It is important for the patient to be well-informed and involved in the decision-making process. Additionally, following the surgeon’s post-operative instructions carefully can help ensure a smooth recovery and minimize complications. Regular follow-up appointments with the healthcare team are also important for monitoring progress and addressing any concerns.

Suitable For

Patients who are typically recommended proctectomy include those with ulcerative colitis, familial adenomatous polyposis, and other severe inflammatory bowel diseases or colorectal conditions that require the removal of the rectum. These patients may have failed medical management or have a high risk of developing colorectal cancer. The decision to undergo proctectomy is usually made in consultation with a colorectal surgeon and gastroenterologist based on the patient’s individual medical history and condition.

Timeline

Before a proctectomy, a patient may experience symptoms such as rectal bleeding, abdominal pain, diarrhea, and urgency to have a bowel movement. They may undergo various tests such as colonoscopy, CT scans, and blood tests to diagnose the condition and determine if surgery is necessary.

After a proctectomy, the patient will typically stay in the hospital for a few days to recover. They may experience pain, discomfort, and fatigue in the immediate post-operative period. The patient will need to adjust to changes in bowel habits and may require a temporary ileostomy (opening in the abdomen to divert waste) which will later be closed in a separate surgery. Physical therapy and dietary changes may be recommended to aid in recovery. Follow-up appointments will be needed to monitor healing and address any complications that may arise. Long-term outcomes and quality of life issues will need to be monitored to assess the success of the surgery.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about proctectomy:

  1. What are the reasons for recommending a proctectomy in my case?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the difference between robotic proctectomy and laparoscopic proctectomy in terms of outcomes and recovery?
  4. How long will the surgery take and what is the expected length of hospital stay?
  5. Will I need a temporary ileostomy after the surgery and for how long?
  6. What is the expected recovery time and when can I return to normal activities?
  7. Are there any long-term effects or considerations I should be aware of after the surgery?
  8. What are the chances of the disease recurring after the surgery?
  9. What is the surgical team’s experience with performing robotic proctectomy or laparoscopic proctectomy?
  10. Are there any alternative treatments or procedures that I should consider before deciding on surgery?

Reference

Authors: Violante T, Ferrari D, Mathis KL, Behm KT, Shawki SF, Dozois EJ, Cima RR, Larson DW. Journal: Dis Colon Rectum. 2024 Nov 1;67(11):1437-1442. doi: 10.1097/DCR.0000000000003465. Epub 2024 Aug 1. PMID: 39087676