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July 19, 2021 | Christopher DeFrancesco '95 (CLAS)-UConn Health

Traditional surgery and minimally invasive laparoscopic surgery still have limitations in terms of access, visibility and accuracy. As UConn Health's colorectal surgeon Dr. Eric Girard explained, robot-assisted surgery can overcome these obstacles—and in many cases, eliminate them.

Dr. Eric Girard demonstrated the operation of robot-assisted surgical instruments. (Photo by Frank Barton)

The patient will feel much better afterwards. It is very different. — Dr. Eric Gillard

Traditional surgery and minimally invasive laparoscopic surgery still have limitations in terms of access, visibility and accuracy. As UConn Health's colorectal surgeon Dr. Eric Girard explained, robot-assisted surgery can overcome these obstacles—and in many cases, eliminate them.

Why is robotic surgery more and more popular?

If you are looking for patients who want the fastest recovery, the fastest return to work, and the least discomfort, one of the most important things we can provide them is safe and effective surgery. In many cases, we can shorten the patient’s hospital stay to less than 24 hours, while laparoscopic surgery takes 3 to 4 days and large open surgery takes 7 to 10 days, after which the patient will feel much better. It is very different.

We are doing an internal anastomosis, which basically puts the intestines in the abdomen together. It leads to reduced bowel obstruction (slower bowel), less anastomotic leakage (a potential complication of gastrointestinal surgery), shorter hospital stays and better recovery. People go home earlier and return to work earlier, and overall people perform better.

To explain further, your intestines are likely to be in a fixed position. When we have to take out one part, we have to move and manipulate the intestine to free it from its attachments so that it will reach the other part of the intestine when we put it back in place. The act of putting the two ends back together is considered an anastomosis.

What other programs can robotics have a significant impact on?

Colon cancer, rectal cancer, diverticulitis, inflammatory bowel disease, these are big problems, at least for me. Anyone who has these problems, we can deal with them automatically. We are removing cancerous tissue, or in the case of diverticulitis, we are removing a section of the inflamed colon and putting it back in place, so that people don’t have repeated infections that cause them pain, hospital stays, and their intestines There may be a hole, leading to a stoma, and a bag is needed.

When you have a person with severe inflammation, whether it is a patient with diverticulitis, fistula disease, Crohn's disease, or the like, you can really make a difference through robotics. When you have inflammation, your body tends to form a hard shell around the source of the inflammation. It is difficult to find a suitable area, such as two organs fused together. Robots help me do this better than laparoscopic surgery. When you connect the colon to the bladder through a laparoscope, most people will have to open it and reach there to feel the connection, and I can manipulate the bladder through a robot. Instead of just having a straight tool, I can walk behind it with my wrist instrument and operate it in such a way that I can see the plane. I have a third hand instead of two.

What are the advantages of robotic methods?

I can see in 3D vision that I have the ability to use fluorescent dyes, where I can 100% ensure that there is good blood flow to my anastomotic area. I have better visualization, and I am more sure what I am cutting when I cut.

When you have a robotic instrument, it is actually the same instrument that you will use in your hands. No matter what you have at your fingertips, no matter what surgical instrument your surgeon will use, it is exactly what the robot allows you to do. So if I want a pair of scissors, I put the scissors on my tip and I can use it like a finger, or if I have a gripper, I will use it, and I can put it in any direction. It mimics my movements, eliminates any tremors and stabilizes the instrument. It can make your movements very fine, and if you have larger movements, it will actually narrow them down to very fine movements. And you get a significant zoom effect, so you can really watch it up close.

How does robotic surgery adapt to the concept of accelerated postoperative rehabilitation (ERAS)?

This is all the part that allows the patient to return to normal as soon as possible and return home as soon as possible. Enhancing postoperative recovery has a lot to do with keeping them from getting out of their daily routines. We don't starve them to death; we let them eat as soon as possible. We tried to get the patient to get up and walk immediately. If they are doing everything they do at home, then they can do it at home. We have 24/7 service; if they have any questions, they can call for help, but most people won't. Once they have checked all the boxes that they did well, they will go home so that people can get back to their families faster.

We can do anything in the body, so this means less tissue damage in the process of connecting the intestines together. Our goal is to put everything back together in a way that you can continue to work, and there is almost no change or interference in your normal life.

Who else is doing this?

Many other services use it similarly, such as GYN for the treatment of endometriosis. Our gynecological oncologist is using it. We have thoracic surgeons who are removing part of the lungs. We performed advanced hernia repairs with many general surgeons. Everyone is using this advanced minimally invasive method because most people feel that they give patients a better chance, allowing them to be discharged faster and recover better.

Learn more about surgery at UConn Health. Or call 860-679-8080 to schedule a consultation.

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