When Robert Mendys was diagnosed with stage III rectal cancer in December 2014, he faced a profound dilemma. He wanted to make sure the cancer didn’t take him away from his wife and three young sons. But at only 46, he was very concerned about the long-term effects of surgical treatment.
“I felt that I had one shot at getting this right,” he says. “I needed to make sure I could still be here to watch my kids grow up. But I also read on patient websites that many who have had rectal surgery were having problems with urinary control and sexual dysfunction due to nerve damage.”
A former pharmaceutical sales representative living in southern New Jersey, Mr. Mendys sought the advice of his friends in the medical field and did more internet research. He learned that a minimal-access technique called robot-assisted surgery could reduce the risk of side effects — and that Memorial Sloan Kettering had one of the most active robotic surgery programs in the nation.
After receiving initial treatment of chemotherapy and proton therapy at the University of Pennsylvania to drastically shrink the tumor, Mr. Mendys came to MSK for a consultation with Julio Garcia-Aguilar, Chief of the Colorectal Service in the Department of Surgery.
Dr. Garcia-Aguilar immediately put him at ease. “Dr. Garcia-Aguilar had more than 20 years of experience with minimal-access surgery — and nine years performing robotic surgery — and his assistant told me he performs several robotic procedures a week,” Mr. Mendys says. “That really made a difference for me, knowing I would be treated by someone with that kind of expertise.”
Expanding Use of Robotic Surgery
Mr. Mendys is one of a growing number of patients benefiting from robot-assisted surgery, an enhanced minimal-access operation. Unlike traditional open surgery, minimal-access surgery involves the use of keyhole-size incisions, which often results in less pain and blood loss, a shorter hospital stay, and a faster recovery.
In robotic surgery, a surgeon sits at a console and uses hand and foot controls to manipulate four interactive robotic arms, which are equipped with a high-definition vision system. The robot translates the surgeon’s hand, wrist, and finger movements into movements of the actual surgical instruments inside the patient.
Surgeons can see the site of operation better because the “eyes” of the device — the camera — can go very close to the tissue and project a three-dimensional image that’s then magnified tenfold. In addition, the robot takes the surgeon’s motions and scales them down, allowing for enhanced precision.
When robotic surgery devices began to emerge around 2000, MSK quickly recognized the potential for expanding the number of minimally invasive procedures. MSK now has the largest robotic surgery program in the United States.
A Tool in Expert Hands
Gynecologic surgeon Mario Leitao, Director of MSK’s Minimal Access and Robotic Surgery Program, emphasizes that the expertise of MSK’s surgeons is what makes robotic surgery safe and effective.
“The deciding factor is that it is the skill of the surgeon, working with the tool that he or she is most comfortable with, that gets the best result,” he says. “The idea is not to use the robot as much as possible but to ask, ‘What’s the best approach to curing your cancer and giving you a normal life afterward?’”
The majority of robotic operations at MSK are performed for gynecologic and urologic cancers, most typically hysterectomies (removal of the uterus) and radical prostatectomies (removal of the prostate). But robotic procedures are used for a variety of other cancers as well.
Leadership in Colorectal Cancer
MSK leads the nation in volume of robotic colon and rectal surgeries, with approximately 370 performed in 2015 alone.
The robots have been continually refined over the years, with better technology added for each new generation of devices. The newest model, the da Vinci Xi, has longer arms that can rotate a full 180 degrees, enabling better access to specific sites in the patient, and includes a stapling instrument that allows the surgeon to sew the healthy parts of the colon together.
“These enhancements make it easier for the surgeon to work with more precision, which should lower complication risks even further while maintaining good outcomes regarding the treatment of the cancer,” Dr. Garcia-Aguilar says. “This means less postoperative pain, lower infection rates at the surgical site, and a lower risk of complications such as bowel obstruction and abdominal hernia.”
A Faster Recovery
For Mr. Mendys, the benefits of robot-assisted surgery were obvious. With no significant side effects, he was discharged from Memorial Hospital and on his way home in just 72 hours.
“When I woke up from the operation, I saw there were just five half-inch or quarter-inch incisions around my belly button,” he says. “The first question Dr. Garcia-Aguilar asked me was whether everything was working properly regarding urination and bowel function. It was really important to him. I credit his surgical skills with the robot for the success of the operation and my recovery going so smoothly. It shows the importance of patients and caregivers doing their research to find a healthcare professional who specializes in treating their condition.”