A milestone TME becomes 100th da Vinci surgery at Mediclinic Bloemfontein

Mediclinic Bloemfontein general surgeon Dr Francois Kruger recently performed his tenth total mesorectal excision (TME) on the da Vinci robot. 

In addition to this achievement, the surgery also marked the 100^th da Vinci case completed at the hospital.

A significant landmark for Mediclinic Bloemfontein

Reaching a 100 da Vinci procedures is a remarkable accomplishment for Mediclinic Bloemfontein says Dr Kruger. Commending the hospital for initiating surgeries with the da Vinci – a minimally invasive robotic surgical tool offering enhanced accuracy, flexibility and control – he says that Mediclinic clearly sees the advantage for patients.

“The team here has done a lot of cases with very good outcomes, and it's also a big drawcard for Mediclinic and for the whole of central South Africa that we can do these cases here.” It reflects Mediclinic Bloemfontein’s continued dedication to surgical excellence, innovation, and improved patient care.

While the technology has been around for a while, having the da Vinci offers a major advantage for patients with certain malignant diseases that require surgery.

For now, the da Vinci can be used for colon cancer surgeries, like the TME performed for rectal carcinomas, as well as left and right hemicolectomies to remove either side of the colon. Other available da Vinci surgeries include hysterectomies, prolapse surgeries, radical prostatectomies for prostate carcinomas, and nephrectomies.

Understanding the TME

The 100th da Vinci surgery performed at Mediclinic Bloemfontein in May was a TME performed on an elderly patient with a rectal cancer that was very low down in the rectum. “A TME is the excision of the whole rectum as well as all the lymph nodes and tissue surrounding the rectum, essentially a complete excision of the rectal carcinoma,” Dr Kruger explains.

Once patients are diagnosed with a rectal carcinoma, a type of colorectal cancer originating in the rectum, they are given neoadjuvant chemotherapy and radiation – treatment given before primary surgery. Following effective treatment, the next step in the oncological management of the condition is to get rid of the carcinoma through a TME.

However, the general condition of the patient must be considered before surgery can take place, Dr Kruger explains. “If they don't adequately respond to their chemotherapy or there is growth of the tumour infiltrating more structures, it makes the procedure a lot more complicated.”

Da Vinci benefits for TME patients

With colorectal surgery, for a TME or a colorectal carcinoma, there is a very narrow space to work in, says Dr Kruger, which makes open and laparoscopic procedures difficult. “The main advantage of the da Vinci is that you can get very close to the tissue. We control the camera ourselves and can move in on a specific plane. Because of the magnification, visibility of the tissue planes is a lot better, and you can work more accurately in very tight spaces. It also helps us to bring down the anastomosis leak percentage after procedure.” This where a new connection (anastomosis) between two hollow organs – such as parts of the intestine – breaks down or fails to heal properly.

With the da Vinci there is also less risk of blood clots due to faster post-operative mobilisation, and the patients tend to recover a lot quicker after the procedure, he adds. While the standard hospital stay after an open TME is between seven and 10 days, and five to seven days with laparoscopic procedures, with the da Vinci, TME patients can be discharged after day three. This is because they mobilise earlier and experience less pain, leading to less respiratory complications and less ileus – when your intestine temporarily can't push food and waste out of your body.

In this particular case, using the da Vinci also promoted better quality of life. As the elderly patient had a very low rectal carcinoma, less than a centimetre from the anal sphincters, Dr Kruger explains. “Normally we would remove the whole sphincter complex with that, taking away the whole anus, which means she would need a permanent stoma,” says Kruger, “but she didn't want that.”

Dr Kruger therefore performed his first TME with intersphincteric dissection and coloanal anastomosis. “With the da Vinci, we were able to dissect very low down, and operate from the bottom, taking away only a part of the anal sphincters and doing a coloanal anastomosis,” he explains. “This means we sutured the colon onto the skin just outside the anus and were thereby able to avoid removing the entire sphincters. Currently the patient still has sphincter function and is doing very well.”