John Cromwell, MD, of the University of Tennessee Health Science Center and Methodist University Hospital's Minimally Invasive Surgery Center (MISC), has performed one of the first robotic colorectal surgeries in the state and Southeastern region.

 

"We're very fortunate to be on the forefront of robotic surgery here at Methodist University Hospital," said Cromwell, medical director of colorectal surgery and chief of colon and rectal surgery.

 

The idea for the MISC began a few years ago, when Methodist University Hospital began minimally-invasive bariatric surgery. It has evolved to currently include multiple disciplines, such as colorectal and general surgery, gynecology,  urogynecology, urology and gynecologic oncology.

 

"We're trying to roll the minimally-invasive services across disciplines and under one roof. A lot of patients are affected by illnesses that are multi-disciplinarian," Cromwell said.

 

An example Cromwell gives is how he often treats patients with rectal prolapse. He explained that many of these patients are then affected by prolapse of other pelvic organs, such as prolapse of the uterus in female patients, or urinary incontinence.

 

"It makes sense for me to manage the problem surgically, then to have the other doctors treat their portions of the patient's illness, so the patient doesn't require surgery with a large incision."

 

Cromwell said that robotic surgical equipment is currently best suited for operating on one particular location of the body, making it ideal for colon surgery. This colon surgery focuses on either the left or right side of the colon, or part of the rectum inside the pelvis. Robotic colorectal surgery can help treat colon polyps, colon cancer, or diverticular diseases including divertulosis and diverticulitis, inflammation of the colon.

 

"(Robotic surgery) allows me to control the instruments much more precisely, and improves visualization of the area I am operating on," said Cromwell. "When I am sitting at the robotic console, my view there is much, much clearer than if I am doing another type of minimally invasive surgery." 

 

Cromwell attributes the key to better visualization during robotic surgery to the depth perception surgeons have while performing robotic surgery. He described laparoscopic surgery, which is viewed on a television monitor, as a 2-dimensional image—similar to viewing something with one eye closed.

 

"We can really provide minimally-invasive solutions for patients from a multi-disciplinary standpoint. To be doing this at the Methodist University Hospital, it also allows us to learn from other specialties and to advance the fields that we're working in. Lastly, it provides an educational opportunity for doctors in training, to be 'doctors of the future' and it exposes them to all these techniques across disciplines," explained Cromwell.

 

"That's one of the main advantages of having all of these surgeons in one center," he continued. "It's not one surgeon looking at how they're doing, but a group of surgeons looking at how they're providing overall care for their patients. I think having multiple specialties really accelerates the pace of improving patient care. So my hope is that not only will we be good stewards of this new technology, but we'll also improve the outcomes for the people of Tennessee."

 

"Right now I'm determining what the advantages are of robotic surgery over laparoscopic surgery, and we're seeing the advantages in very early data," Cromwell continued."Somewhere between 10 and 20 percent of patients would have their surgeries converted from minimally-invasive procedures to open surgeries. With the da Vinci robotics machine, we've cut the need to convert surgeries to about half that—due to the enhanced visibility and the precision of the instrumentation."

 

To learn more about robotic surgery and to view a robotic colorectal surgery, visit www.methodisthealth.org/MIS.