Javier Salgado, MD, Assistant Professor of Surgery and Colorectal Surgeon at UPMC talks about a new robotic device that helps with visualization of tumors and improves surgery.
Interview conducted by Ivanhoe Broadcast News in May 2018.
Tell me a little bit about this new device, this new tool that surgeons have at their disposal.
Dr. Salgado: It’s a robotic instrument that allows you to perform different transanal surgeries, expediting the patients recovery and minimizing the possibility of pain. Minimizing the need for major complex surgery and overall improving the surgeon’s precision of this isolation of the incisions.
I heard someone refer to it almost like a robotic snake in the way that it operates. Can you describe that?
Dr. Salgado: It looks a lot like a snake so you introduce it in this case with the transanal approach so we didn’t trace it through the anus. We advance it at the level where the tumors are and the robot remains still. So that allows us to have perfect visualization of the lesions and allows us to have a lot of surgical precision when we’re using our instrumentation. And therefore improve the way we resect these lesions.
Prior to having this at your disposal can you describe, especially for someone with a tumor where Kelly’s was positioned, what would her other options have been?
Dr. Salgado: Either do it the regular transanal approaches but that cannot be done when the lesions are higher in the rectum because we cannot reach from below. Or, in cases where tumors are big or cancers are a bit more advanced doing the major abdominal complex surgery.
So before if the tumors were that big you could not use the same approach?
Dr. Salgado: We could not do the same approach.
This robot had been approved for other uses before had it not?
Dr. Salgado: It has. Actually the first specialty where it was approved was ENT. And recently it’s been approved for colorectal surgery.
How many cases have you done and is there a particular patient for whom this is a better option?
Dr. Salgado: Absolutely. The technology is pretty new and we are one of the first to do it nationwide. Our level of expertise in robot has not reached the peak of the incidence or the proficiency yet but we have done a lot of training in labs and with cadaveric lab works where we basically tired to achieve our learning curve before using with patients, absolutely.
And how many have you done?
Dr. Salgado: We’ve done using this particular robotic approach only two.
Tell me about Kelly’s case.
Dr. Salgado: Kelly came to see us after undergoing a screening colonoscopy where they found a large rectal lesion. A biopsy of the lesion did show it was not a cancer it was a benign lesion but it was big enough that it could not be removed via the endoscopic approach. We did this kind of different surgical options and we thought it was a perfect patient selection to proceed with this new technology. We’ve done similar approaches by using the robot so the expertise is there for us but certainly the robot adds a bit more to our surgical armamentarium.
Doe it cut back on the time, is it faster?
Dr. Salgado: It may be faster in the future right now there is no time differences compared to our single transanal approaches but it adds a bit better visualization of the lesions and that allows us to ressect these tumors when they’re a bit higher up via our transanal approach.
You had mentioned that it was large, could you describe how large?
Dr. Salgado: If I don’t recall incorrectly it was more than three point five centimeters and it is not a huge tumor but it’s certainly large enough that they were not comfortable doing it endoscopically. Also the morphologic characteristics of the tumor, how much it expands, how much it extends, if it’s pedumculated and those things, those characteristics of the tumor need to be considered when you want to identify who’s a perfect patient selection to proceed with this approach.
What are the benefits to the patient of having this procedure?
Dr. Salgado: There’s a lot of benefits. If we can do it we have minimally invasive transanal approaches it means that the patient does not require a major amount of surgery. And that’s the main advantage or benefit over other techniques. It minimizes the post operative pain, it improves their recovery, it decreases the length of stay in the hospital and it allows us obviously to offer other surgical strategies to our patients.
Again, benefits to the patient?
Dr. Salgado: There are major benefits to the patient, the main benefit is that if you actually have the adequate patient selection you can avoid patients from undergoing major surgery. That is the main benefit that I do see with this approach. The second benefit is that with minimally invasive transanal robotic surgery patients have a much faster recovery. Without any scars, with minor postoperative pain and with return to the routine and normal activities much faster.
Is there anyone for whom this is not a good idea?
Dr. Salgado: For advanced regular cancer this is probably not a good idea yet. I do think that when we obtain a bit more experience and reach our learning curve it will be an option for the future.
But for someone with an earlier stage cancer this is appropriate?
Dr. Salgado: Early stage cancer on endoscopically benign lesions which cannot be removed, or lesions which cannot be removed endoscopically those are good options.
Is there anything I didn’t ask you that you would want to make sure people know about this?
Dr. Salgado: I think we should mention that robotic transanal surgery is not the only approach that we can offer the patients, it’s just one more approach that we have in our armamentarium in order to achieve better outcomes for our patients.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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