Simultaneous rectal and prostate surgery with da Vinci

The da Vinci robotic system at Mediclinic Durbanville is once again in the spotlight, with what appears to be a world first on the system.

During April, Dr Gawie Bruwer, urologist, and Dr Frikkie Rademan, surgeon, were able to simultaneously remove both rectal and prostate cancer from a 68 year old patient.

According to Dr Bruwer, this is extremely rare, “It is extremely rare to have simultaneous cancers such as this, and none that we know of has been reported in the world literature that have been removed together.” An added complication for this type of surgery is to anastomose both rectum and urinary tract in one operation, without developing adverse complications and breakdown. The precise and secure suture placing is now possible with the enhanced vision of the da Vinci Robot

The patient, a resident of Cape Town, presented with both cancers simultaneously and required intervention by both a urologist and surgeon. “Both organs were removed together in one sitting with the robot and both the bladder and colon re-united,” confirmed Dr Bruwer.

The da Vinci robotic system offers a broader range of movement in what is an exceptionally confined area. “The cancer was low down in the pelvis and as a result there is limited space to work,” explains Rademan, “This is where the robot brings more precision and access during the complicated procedure. We had no experience doing this complicated surgery together and learned a great deal for future cases.

“The histology shows complete removal of both cancers and there is no need for chemo or radiation therapy,” says Dr Rademan. While traditional surgery (without the use of the robot) provides the same prognosis, Dr Rademan indicates that the patient’s recovery is advanced in terms of hospital stay, return to normal routine as well as the return of bladder and sexual function.

Dr Bruwer highlights just what the da Vinci surgery means to a patient, “Firstly these surgeries could be performed together, which reduces theatre time and cost to the patient, but also enabled us to spare both urinary and fecal continence.”

The da Vinci robot has been at Mediclinic Durbanville for several years, with a number of surgeons being accredited on the system. Both Dr Bruwer and Dr Rademan attended a significant amount of training to safely perform surgery with the system. “In my time working on the da Vinci, I am convinced that the training and mentoring has been worth it. Reduced blood loss during the procedure, accelerated recovery times and the quality of life after the nerve sparing precision of the robot, are all significant factors when I discuss the options with my patients,” says Dr Bruwer.