Ground-breaking rectal cancer surgery performed at UHL

THE first Robotic Trans-Anal Minimally Invasive Surgery (TAMIS) for early stage rectal cancer, which was performed recently in University Hospital Limerick (UHL) has placed the hospital on the map as a national centre of excellence for this specialist work.

The robotic team in the Department of Colorectal Surgery at (UHL) recently broke new ground in treatments available in this country for early stage rectal cancer, by performing the first Robotic Trans-Anal Minimally Invasive Surgery (TAMIS) operation in Ireland.

Consultant Colorectal and General Surgeon, Mr Colin Peirce, and the Robotic Colorectal Team and staff in Theatre 7, used the Da Vinci Xi Dual Console robot to perform the surgery, which enables the removal of early stage cancers from the lower bowel whilst leaving the bowel intact, with minimised recovery time for the patient and no requirement for a temporary or permanent stomach bag.

The achievement can place UHL firmly on the map as a national centre of excellence for TAMIS operations, according to Mr Peirce.

“We will be looking to make UHL known as a referral centre in Ireland where we can do this surgery. Now that we have undertaken our first robotic TAMIS, I have no doubt that this type of surgery is the best surgical option for treatment of certain early stage rectal cancers and large polyps,” he said.

Robotic TAMIS is an organ-preserving operative technique, allowing for the removal of early cancers and large polyps from inside the bowel, without removing the affected section of bowel. The operation requires no surgical incisions, as it is performed via the patient’s anal canal.

The surgery has been performed elsewhere in the world, and Mr Peirce says that its availability in Ireland brings huge benefits for patients, clinicians and importantly for hospital capacity also.

Mr Peirce explained the big breakthrough is that this surgical approach saved this particular patient a major abdominal operation with a temporary and possibly even a permanent stomach bag.

“Instead, the patient was admitted the morning of surgery, had the operation, stayed in hospital for one night, and is now cured of their early rectal cancer. We would envisage that these operations could be performed as daycase procedures going forward.”

The versatility of the Da Vinci robotic platform means that Mr Peirce and his colleagues are now able to perform surgeries where a traditional keyhole (laparoscopic) procedure would have proved a lot more difficult, if not impossible.

Mr Peirce said: “This kind of operation, to remove growths from the inside of the bowel, is technically very challenging. Traditionally, it would require the surgeon to make an incision and go through the abdomen and down into the pelvis.

“The portion of bowel with the growth is then removed, the two pieces of bowel either side are joined together with placement of a temporary stoma bag, or indeed it might not be possible to join the bowel back together and the patient would then require a permanent stoma bag. It’s major surgery, and would take in the region of three to four hours. The patient would require a five-night stay in hospital at a minimum.”

“For a robotic TAMIS, the patient will still be under general anaesthetic, but the actual operating time having docked the robot is only about 45 minutes. The surgery is incision-less and organ-preserving, because it takes place inside the bowel and allows us to remove the early stage cancer or large polyp from the bowel wall without removing the whole segment of bowel where the growth is,” he explained.

 

Dan Danaher