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Robot-assisted surgery has helped Mr Mervin Koh successfully recover from rectal cancer with just a few small scars to show for his experience.
Robot-assisted surgery helps colorectal cancer patients
recover faster
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 colorectal 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.”
The man behind the 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 2 1/2 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 miniaturized surgical instruments and a laparoscope, a tiny, flexible tube with a small, high-definition 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.
According to Prof Eu Kong Weng (left), robotic-surgeries (right) typically need just one assistant, unlike conventional colorectal operations, which can require up to four surgeons.
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.
What you need to know about colorectal cancer?
- It’s the most common cancer in Singapore. About 1,500 new cases are diagnosed annually.
- Colorectal cancer occurs at any age, but 90 per cent of patients are over 40 years old. Other risk factors include family history, a personal history of intestinal conditions like ulcerative colitis, diet and a sedentary lifestyle.
- Although there are no symptoms during the early stages of the disease, patients may experience symptoms such as rectal bleeding or blood in the stool, a change in bowel habits (like constipation or diarrhoea), persistent abdominal discomfort (like cramps, gas or pain), and abdominal pain during bowel movements.
- Colorectal cancer requires surgery in nearly all cases for complete recovery, with some patients requiring additional radiation and chemotherapy.
- If detected early, the chance of recovery can reach up to 90 per cent. Otherwise, it drops to less than
50 per cent in advanced cases. Despite this, only 1 in 9 men and 1 in 13 women in Singapore
have undergone a colonoscopy at least once.
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During a speech at Singapore General Hospital’s International Colorectal Congress held last November, Minister for Health Mr Khaw Boon Wan confirmed that the Ministry of Health will launch a colorectal screening programme for Singaporeans and Singapore Permanent Residents aged 50 and above. They can pick up a free Faecal Occult Blood Test at Singapore Cancer Society and other selected locations. See Singapore Cancer Society for more details. |
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