Robotic small bowel resection, which removes the damaged or diseased part of your small intestine, is one of the effective treatment methods offered by modern surgery. The idea of removing a portion of your intestine may be concerning, but in fact, the small intestine is 20 to 30 feet long, and you can live without a part of it.
Small bowel resection can be performed as an open, robotic, or laparoscopic procedure. However, robotic bowel surgery offers significant advantages over traditional methods. In this article, we will discuss what small bowel resection is, in which cases it is applied, and the advantages of robotic surgery in this procedure in a simple and understandable way.
What is Robotic Small Bowel Resection?
The surgical procedure performed to remove a problematic section of your intestines is called "intestinal resection." This procedure can be applied to the small intestine, large intestine, or rectum depending on the patient's intestinal health and needs.
Definition of Small Bowel Resection
Small bowel resection is a surgical procedure performed due to various health issues occurring in the small intestine. In this operation, the problematic section of the intestine is removed, and the healthy parts are connected to each other. The procedure can be performed in cases of obstruction, cancer, or other serious disorders.
Small bowel resection can be performed in three different types depending on the removed area:
Duodenectomy: The procedure for removing the duodenum (the first part of the small intestine). It is usually performed due to tumors or serious damage occurring here.
Jejunectomy: The procedure for removing the jejunum (the middle part of the small intestine). It is applied due to serious infections or tumors.
Ileectomy: The procedure for removing a section of the ileum (the last part of the small intestine). It is performed due to diseases or inflammations occurring in this area.
What is Robotic Surgical Technique?
Robotic small bowel resection is an advanced surgical method that uses robotic systems to remove the damaged or diseased part of the small intestine. In this method, several small incisions are made in the abdominal area to perform the procedure.
During robotic surgery, the abdominal area is first inflated with gas. This allows the surgeon to see the internal organs better. Then, miniature lights, cameras, and small instruments are used to locate, cut, and remove the diseased area.
The surgeon remotely controls the operation using a robotic console. In this system, the surgeon's external hand movements are transferred to the inside of the abdomen with precision by the robot. Robotic arms can reach areas where the surgeon's hand cannot and can perform multiple surgical instrument functions simultaneously.
A particularly important point is that robotic surgery allows for three-dimensional and detailed visualization of the operated area. This enables more precise surgical procedures while protecting small nerves and vessels.
Differences from Traditional Surgery
Robotic small bowel resection differs significantly from traditional open surgery:
Incision size and scar: In open resection, a large incision is made in the abdominal area, while in robotic surgery, only a few small incisions are made. This prevents large scars from forming on the patient after surgery.
Imaging quality: In robotic surgery, the surgeon can view the operated area closely, in three dimensions, and in great detail. This is a significant advantage compared to open surgery.
Surgical precision: The unlimited movement capability of the robotic arm inside and the precise transfer of the surgeon's hand movements allow for more precise surgical procedures.
Recovery process: After robotic surgery, the patient's recovery process is faster. Since the intestinal tissues are less damaged, the process of returning to normal life is facilitated.
Bleeding control: The amount of bleeding in robotic surgery is less. This reduces the risk of postoperative complications.
Hospital stay duration: After robotic surgery, patients can return to their pre-surgery dietary habits more quickly, and the hospital stay duration is shortened.
In conclusion, robotic small bowel resection is a modern surgical approach that is more precise, less invasive, and prioritizes patient comfort compared to traditional methods.
In Which Cases is it Applied?
Robotic small bowel resection plays an important role in the treatment of various small intestine disorders. This surgical approach offers patients a reassuring treatment option depending on the type and progression of the disease. So, in which cases is this method used?
Crohn's Disease
Crohn's disease is a chronic inflammatory bowel disease that causes thickening and ulcers in the intestinal wall. This disease can affect the mouth, esophagus, stomach, small intestine, large intestine, and anus, but most commonly affects the last part of the small intestine and the large intestine.
Robotic small bowel resection is particularly preferred in the following situations:
Inability to achieve positive results with medication treatment
Inability to continue medication treatment due to side effects
Development of stricture or fistula in the intestine
Formation of abscess in the abdominal cavity
Development of abscess or fistula around the anus
Depending on the severity and duration of Crohn's disease, narrowing can develop in the intestinal canal, leading to symptoms such as abdominal pain, nausea, vomiting, and abdominal swelling. Robotic surgery allows for the precise removal of the diseased area, improving the patient's quality of life.
Small Bowel Tumors
Benign or malignant tumors that develop in the small intestine are an important indication for robotic small bowel resection. These tumors can disrupt the normal function of the intestine, causing obstruction or perforation.
Small bowel tumors can be safely removed with minimal invasive approaches. Robotic surgery offers a faster and easier recovery process without the need for the large abdominal incision required in open surgery.
Robotic surgery is an ideal option for tumors that are not close to critical structures such as the pancreas and liver. However, open surgery may be necessary for large tumors and those close to critical structures.
Intestinal Obstruction
Intestinal obstruction is one of the emergency situations that require small bowel resection. The obstruction can occur due to tumors, adhesions, twisting of the intestinal loops, or other reasons.
Robotic small bowel resection offers the following advantages in cases of intestinal obstruction:
Less trauma due to smaller incisions
Quick recovery process
Less pain after surgery
Faster return to normal intestinal functions
Intestinal obstruction is a serious condition that requires emergency intervention, preventing the passage of food, fluid, or gas that accumulates in the small intestine. Robotic surgery provides the opportunity for precise intervention in this situation.
Trauma and Injuries
Severe injuries occurring in the small intestine can result from trauma. For example, a person who has experienced abdominal trauma due to an accident may have damage to the small intestine. Moreover, digestive system surgery may be necessary for injuries resulting from trauma.
Robotic surgery provides the following benefits in intestinal repair after trauma:
Precise removal of damaged tissue
Preservation of healthy tissues
Reduced risk of postoperative complications
Other Small Bowel Diseases
Robotic small bowel resection offers precise and minimally invasive surgery with rapid recovery, less pain, and minimal scarring. It is ideal for Crohn's disease, tumors, and obstructions.
Thanks to this advanced technology, the presence of vessels and nerves can be clearly seen. The robotic system is particularly useful for distinguishing and protecting small nerves and vessels. As a result, it provides a more comfortable working environment for the operating surgeon while ensuring a safer operation for you.
How Does the Surgery Process Progress?
Robotic small bowel resection surgery is a process performed with one of the most advanced technological methods in modern medicine. Knowing what to expect from pre-operative preparations to the recovery period will help you go through the operation process more comfortably.
Pre-operative Preparation
First, a detailed evaluation is conducted before robotic small bowel resection. During this process, blood tests, imaging tests (such as CT, MRI), and anesthesia examination are completed. Your surgeon will utilize these tests to determine the exact location and condition of your disease while creating the surgical plan.
Bowel cleansing is an important step to reduce the risk of infection. Typically, a liquid diet is applied 24-48 hours before surgery, and your intestines are ensured to be completely empty. During this period, you may be asked to consume:
Water
Clear fruit juices
Fruit-flavored drinks
Tea or coffee without milk or cream
Strained tomato or vegetable juice
Fat-free broth
Additionally, it may be necessary to stop or adjust the doses of blood-thinning medications before surgery. These adjustments are important to reduce the risk of bleeding.
Anesthesia and Start of Surgery
Robotic small bowel resection surgeries are performed under general anesthesia. Thus, you will not feel any pain during the surgery. The anesthesia specialist will create an appropriate anesthesia plan after evaluating your suitability for anesthesia.
You will be positioned appropriately for the surgery (usually in lithotomy or modified lateral position). After this stage, the robotic arms are covered with sterile drapes, and your abdomen is inflated with CO2 gas. This process is necessary for the surgeon to see the internal organs better.
Use of Robotic System
Several small incisions (approximately 8 mm) are made in your abdominal wall, and robotic ports are placed through these incisions. A three-dimensional robotic camera is placed in one of the incisions, while robotic arms are attached to the others.
After positioning the robot (the docking process), your surgeon moves to the console. At this stage, one surgeon stands next to your operating table, while the other surgeon is at the console. The surgeon sitting at the console performs the operation with 10-15 times magnified, high-resolution, and tremor-free 3D images.
While the surgeon controls the robotic arms with computer assistance, these arms mimic his hand and wrist movements. This system offers more movement capability (540 degrees) than the human hand, and all stages of the surgery are conducted from here.
During the operation, after the diseased part of the small intestine is disconnected from the surrounding tissues, it is removed from the body, and the healthy parts are joined together to create a new connection (anastomosis). After the completion of the surgery, the robotic arms are detached, and the small incisions are closed.
Post-operative Process
The recovery process after robotic small bowel resection is remarkably fast compared to open surgery. Your hospital stay is generally 3-5 days, while this duration can extend to 7-10 days in open surgeries.
From the 6th hour after surgery, you will start taking short walks. This is very important for the initiation of bowel movements and the expansion of your lungs. Your bowel movements generally return within 1-2 days, and you can quickly transition from liquid foods to solid foods.
Your dietary progression is as follows:
Initially, feeding is generally started with intravenous nutrition and clear liquids
Your diet is gradually increased as you pass gas
When discharged, a low-fiber diet is recommended
After discharge, you can generally take care of yourself and move comfortably within the house. Returning to a desk job is usually possible within 2-3 weeks. During the follow-up examination conducted 1-2 weeks after surgery, your recovery process is evaluated, and your pathology results are reviewed.
Frequently Asked Questions
How long does the surgery take?
Robotic small bowel resection surgery generally takes between 3-5 hours. This duration may vary depending on the individual situation and the complexity of the surgery. Robotic general surgical procedures are mostly completed within 1 to 4 hours. However, what is important is not the speed of the surgery, but that it is performed safely and in a controlled manner. Therefore, some complex cases may take longer.
How long is the recovery period?
The hospital stay after robotic small bowel surgery is generally between 3-5 days. This duration is much shorter than the 7-10 day stay in open surgeries. The initial recovery period lasts 4-6 weeks, while returning to normal activities may take a few months. Returning to a desk job is usually possible within 2-3 weeks. It is recommended to avoid heavy activities during the first 6 weeks after surgery.
How should nutrition be after surgery?
Post-operative nutrition progresses gradually. Initially, it starts with liquid foods and gradually transitions to solid foods. In the first days, intravenous nutrition and clear liquids (water, broth, tea) are preferred. As bowel movements begin, soft foods like yogurt and soup are introduced. In the following days, continue with low-fiber, easily digestible foods. You should avoid fatty, spicy, and gas-producing foods.
What are the risks and complications?
The risk of complications in robotic small bowel resection is low. Possible risks include wound infection, bleeding, and most importantly, anastomotic leakage (leakage from the connection site). Additionally, infections, blood clots, and urinary issues may occur. Rarely, technical malfunctions may occur in the robotic system, or the surgery may be converted to open surgery. Doctor experience and proper patient selection minimize these risks.
What is the cost of the surgery?
The cost of robotic small bowel resection is higher than that of classical surgery. The price varies depending on the experience of the surgeon performing the surgery, the location of the hospital, the technology used, and additional services. In some cases, SGK may provide partial payment, but it does not cover the entire cost. Many private hospitals offer installment payment options. For accurate cost information, it is best to consult with your doctor and the hospital after the examination.
In Summary, Robotic Small Bowel Resection
In conclusion, robotic small bowel resection is one of the most effective surgical methods offered by modern medicine. Compared to traditional open surgery, this technological approach significantly eases your life. Thanks to smaller incisions, minimal scars remain on your body, and your recovery process accelerates.
When you choose robotic surgery for your bowel problems, your postoperative pain level decreases significantly. Additionally, your hospital stay is shortened, and you return to your daily life more quickly.
When small bowel resection is needed due to Crohn's disease, tumors, obstructions, or trauma, robotic surgery offers you significant advantages. Your surgeon can see the finest details with 3D imaging and precise robotic arms, protecting your vessels and nerves.
In the first days after surgery, your nutrition, which starts with liquid foods, quickly returns to its normal routine. The risk of medical complications is lower compared to open surgery. Thus, you achieve your health in a safer way.
Robotic small bowel resection provides more precise results than traditional methods thanks to robotic arms that mimic the surgeon's hand and wrist movements. This precision makes a significant difference in the treatment of your small bowel issues.
It is important to openly discuss all your questions with your doctor and to carefully follow the pre-operative preparation process for a successful outcome. The advantages provided by robotic technology ensure that your small bowel surgery is less traumatic and that your quality of life rises rapidly.
Robotic small bowel resection can also be applied in the following conditions:
Small bowel perforation: When a hole or tear occurs in the wall of the small intestine, surgical intervention may be necessary. Perforation can occur after trauma, ulcerative colitis, or Crohn's disease.
Small bowel fistulas: A fistula is when the intestines abnormally connect to another organ, cavity, or skin surface. Small bowel fistulas can occur due to Crohn's disease, diverticulitis, abscesses, or surgical interventions.
Bleeding situations: Severe bleeding occurring in the small intestine can also be treated with robotic surgery.
In conclusion, robotic small bowel resection is an effective option for the treatment of various small bowel diseases. This approach accelerates the healing process and improves the quality of life for patients due to its minimally invasive nature and the advantages it offers.
Advantages of Robotic Small Bowel Resection
Robotic surgery offers various advantages to patients undergoing small bowel resection operations. Compared to traditional open surgery, the robotic system provides a less traumatic surgical process and significantly improves your quality of life. This technological advancement has opened a new era in the treatment of your small bowel issues.
Smaller Incisions and Less Scarring
Robotic small bowel resection does not require a large incision in your abdomen. Instead, a few small incisions are made in the abdominal area, and the surgery is performed through these incisions. The incisions typically range from 2-4 cm to 8 millimeters in size. While open surgeries leave a large scar on your abdomen, this is not the case in robotic surgery.
Thanks to these small incisions, surrounding tissues are less damaged. Additionally, the scars left on your body after surgery are minimal in size. This also helps you feel better aesthetically.
Faster Recovery Process
The recovery process after robotic surgery is much faster compared to open surgery. Thanks to the minimally invasive approach, you can return to your normal life in a shorter time. The speed of return to normal intestinal function also increases.
Minimal tissue trauma is the most important factor that speeds up your recovery process. After robotic small bowel resection, you can return to your dietary habits more quickly, allowing you to adapt to your daily life rapidly.
Less Pain and Discomfort
Due to the absence of large surgical incisions, postoperative pain is significantly reduced. After robotic bowel surgery, less pain medication may be sufficient. Thanks to small incisions and minimally invasive techniques, the sensation of pain is significantly decreased.
Moreover, your discomfort after surgery is much less compared to traditional open surgery. Patients generally experience a more comfortable recovery process.
Shorter Hospital Stay
The hospital stay after robotic small bowel resection is generally between 3 to 5 days. In contrast, this duration can extend to 7-10 days in open surgeries. This difference allows you to return to your normal life more quickly.
The acceleration of recovery reduces your hospital stay duration. Additionally, since the speed of return to normal bowel activities increases after surgery, you can be discharged from the hospital earlier.
Lower Risk of Complications
Robotic surgery, thanks to its minimally invasive approach, reduces the risks of bleeding, infection, and tissue damage compared to traditional open surgery. Precise and controlled surgery reduces bleeding during the operation. Moreover, the small incision areas decrease the likelihood of infection.
Additionally, the local recurrence rate is lower in operations performed with robotic surgery systems compared to open surgeries. Controlled surgery significantly reduces postoperative risks.
More Precise Surgical Control
The robotic system allows the surgeon to perform movements with millimetric precision. These features provide the surgeon with the following advantages:
Unlimited movement capability of robotic arms inside
Ability to move in 720 degrees
Filtering of the surgeon's hand tremors
Three-dimensional and 10x magnified high-resolution images
