Mediclinic Durbanville surgeon among first to use Da Vinci robot for colorectal surgery

Dr Jaco Botes, a surgical gastroenterologist specialising in colorectal and hernia surgery at Mediclinic Durbanville, is one of the first certified surgeons for robotic-assisted colorectal surgery. He explains the benefits of the Da Vinci robot.

As an active member of the Da Vinci robotics team, Dr Jaco Botes has been part of several groundbreaking robotic achievements in South Africa. He is the first surgeon in the country to be certified in robotic surgery for both colorectal and hernia procedures and been involved with over 100 colorectal surgeries using the Da Vinci robot.

How the Da Vinci robot works

Simply put, the Da Vinci robot is a robotic-assisted surgical device that provides a less invasive way to perform surgery, using its robotic arms and small camera for precision.

“It allows a surgeon to manipulate the robot, which then does the operation on the patient,” says Dr Botes. “It also has wrists attached to the device, so it feels like you're operating with your hands instead of very long stick instruments. A small downside is that there is no tactile feedback, so you must work with your hands and what you see.”

But the benefits are great. “It’s different to normal laparoscopic surgery in that the robot does finer work, allowing surgeons to do more intricate operations. The benefit in colorectal surgery is it allows us to work in very small, confined spaces, as if it’s open surgery, in the pelvis and anywhere in the abdomen. You can now do the very difficult, intricate and detailed procedures through keyhole surgery, whereas in the past this could only be done through open surgery.”

The benefits of robotic-assisted colorectal surgery

Dr Botes explains that the main benefits of using the robot are that it allows for minimally invasive surgery and greatly improves visibility. “The robot's camera has 10 times magnification, giving a 3D, high-definition view,” he says. This clearer view is especially important in colorectal surgery, as it helps reduce the risk of nerve damage.

Pelvic floor nerves are hard to see during surgery, says Dr Botes. “In open or laparoscopic surgery, it’s often difficult to spot and protect these nerves. You might not even realise you’ve passed them. With robotic surgery, they’re much easier to see.” While skilled surgeons can reduce the risk in traditional methods, the robot simplifies the process, leading to better outcomes for nerve function, he adds. “The biggest difference with robotic surgery is the improved quality of life after the operation.”

For this reason, robotic-assisted colorectal surgery results in better patient outcomes. “The robot is another tool we can use to help patients recover faster and return to a normal quality of life as quickly as possible,” he explains.

Faster recovery is possible because minimally invasive surgery uses smaller cuts, which reduce the risk of infection, blood loss, and pain. This also means patients can leave the hospital sooner. “The patient experience is a lot less traumatic. Everyone benefits to some extent, but robotic surgery is especially helpful for high-risk patients, such as the elderly, overweight individuals, or those needing complex procedures.”

Suitable types of surgery

The Da Vinci robot is currently used in colorectal surgeries including those that remove cancerous tissue that has developed in the colon or rectum. Dr Botes says it’s not just about successfully removing the cancer; it’s also about how well the patient recovers overall after the surgery. The robot is also ideal for pelvic floor surgeries, which are in deep, dark space within the body, he continues. Examples of this are surgeries for pelvic floor prolapse, and rectal prolapse. In addition, robotic surgery is helpful for complex non-cancerous procedures, like diverticulitis surgery.

Dr Botes also advocates the use of the robot in hernia surgeries. He explains that with robotic surgery for hernias, you only need three small cuts, each 5-8mm. The alternative is open surgery, as laparoscopic tools can’t perform the same technique due to their limited flexibility.

“So, suddenly, there’s a huge difference in a patient’s recovery time and in their postoperative experience,” he says. “With open hernia surgery, a patient feels weak, sore, has an extended admission, and must recover from a large incision on their abdomen. Whereas with a robot, we discharge them the next day, or often the same day. It’s a massive difference.”