Robotic Right Hemicolectomy

What is it?

A right hemicolectomy is an operation to remove the right part of the colon (ascending colon). This can be done using a surgical robotic system. An extended right hemicolectomy also includes the middle part of the colon (transverse colon).

Why is it done?

Most commonly it is performed for cancer of the colon, but it can also be necessary for other diseases such as inflammatory disease (colitis or proctitis), diverticular disease, fistulas (inflamed channels) between the rectum/colon and the bladder and other organs.

How does it work?

Up to 5 small instruments are inserted through small cuts into the abdominal cavity. The abdominal cavity ins inflated with CO2 gas to create a ‘working space’. Blood vessels leading to the colon are identified and carefully divided and sealed. The section of bowel that is to be removed is freed up by dividing connective tissues. Then, the bowel is divided using specifically designed stapling devices, and the bowel is removed through a small incision in the lower abdomen (similar to a small caesarean section scar). Finally, the two ends of the bowel are reconnected using yet another stapling device.

How long does it take?

The operation lasts 2-3 hours depending on the complexity.

Is it painful?

You won’t feel any pain during the operation. When you wake up from the general anaesthetic, you should be pain-free and appropriate pain medicine is given throughout your journey to ensure that you will not feel any or only minimal pain.

Do I need a general anaesthetic (GA) or can it be done under local?

You will need a general anaesthetic. These procedures cannot be done under local or regional anaesthetic. In most cases we will however offer a spinal tap in addition to the GA, as this will help to reduce pain medicine requirements during and after the operation.

How can I prepare for the operation?

Preparation is very important and often underestimated. The success of the operation depends broadly on three things: the quality of surgery, the underlying disease and your fitness. I will always strive to deliver best possible surgical quality and suggest the right operation for you. I some cases we can optimise the underlying disease, e.g. by giving you chemotherapy before an operation (see cancer treatment) or optimising the medication for a potential heart condition, diabetes or lung disease. In most circumstances you can contribute to a successful treatment by improving your fitness in the days or weeks leading up to the operation. This can be achieved by exercise, going for daily long walks, eating a healthy diet, stop smoking and reduce alcohol intake. We are happy to give you some specific advice how you can achieve these goals.

Do I need to empty my bowels/ take bowel preparation medicine?

Yes. We recommend taking full bowel preparation and a short course of antibiotics the day before the operation (similar to when you have a colonoscopy). This can be done at your home.

Do I need a stoma bag?

You don’t need a stoma bag. In rare circumstances that may require a stoma bag, we will specifically talk to you about it.

Will my bowels work normally after the operation?

Yes. Your bowel should end up working the same as before. Only very few people experience a slight change in frequency. Having said that, you may experience in the first days after the operation some changes, such as bloating, some loose stools or constipation. This will return back to normal.

What is the risk of complications?

The overall risk of complications depends on the exact nature of your disease, the operation and your fitness. On average there is a 15-20% risk of experiencing any complication. The majority of problems can be categorised as minor (i.e. easy to manage medically), but even minor problems can be uncomfortable for you and delay your hospital stay.

Here is a list of common and rare complications (all % number are averages and may differ significantly for you):

- Wound infection (10%), treated with dressings and/or antibiotics

- Chest infection (2-5%), treated with antibiotics

- Urine infection (2-5%)., treated with antibiotics

- Nausea and vomiting (20%), treated with anti-sickness medication, tube in the stomach

- Anastomotic leak (2-5%), the connection of the bowel is not healing properly and causes an infection, can be treated with antibiotics, in more severe cases another operation may be required.

- Bowel dysfunction. Extremely rare.

- Hernia (1%). Hernias in the area of the surgical incisions are extremely rare.

- Bowel adhesions (scars in the abdomen). The risk is minimal due to robotic surgery, but sin rare cases scars can cause passage problems (bowel obstruction)

- General, severe complications, such as a heart attack, clots in the lung vessels or a stroke are very rare, but the risk can be elevated in patients with certain underlying conditions. We will talk to you in detail about those, if applicable.

Is it possible that I don’t wake up after the operation?

The short answer is no, it is not possible. Th long answer is that a general anesthetic is safe and severe complications resulting in death is as low as 1 in hundreds of thousands. Hence, the chances to die on the operating table are almost 0. There is however some mortality as a consequence of this operation. Overall 1% of patients die in the first weeks after this operation, and in most cases, they have experienced a catastrophic complication or have already an extreme high-risk profile before the operation. If we have any concerns about this, we will talk to you extensively before making any decision.

What can I eat after the operation?

You will be able to eat and drink immediately after the operation. We usually recommend starting carefully by having small meals and distribute food intake over 5-6 occasions during the day while you are in hospital. At home you should be able to have a normal food pattern again. Depending on your operation you may experience that certain foods (e.g. high-fibre content) will result in loose stools and adjustments may be necessary. We will support you with the input of nutrition specialists should this be necessary.

How long do I have to stay in hospital?

You can leave the hospital as early as two days after the operation. This, however, only applies to a minority of patients who have a high level of fitness, experience no complications and have good support at home by friends and family. In most cases the hospital stay is 3-6 days. If you experience any complications, this can be longer.

When can I return to work?

It depends on the nature of your work and what kind of additional treatment you may require. In the best case you maybe able to do some light office work 2-3 weeks after your coming home, but in the case of more physical work it may take 2-3 months as a minimum.

When can I drive?

You can drive when you are safe to drive. As a ballpark measure, you should be able to make an emergency stop. You should not take any pain medication that may impair your awareness (opioids and similar) when you drive. It is best to check with your insurance if they have any specific rules for driving after surgery.

Does the operation need to be performed with a robot?

No. The same operation can also be performed by keyhole surgery (laparoscopy)