Patient Relations
Dr. Haytham Sumrien conducts minimally invasive robotic surgery on patient with colon cancer using the subileal dissection technique for right hemicolectomy
A surgeon at Johns Hopkins Aramco Healthcare (JHAH) has conducted the first known minimally invasive robotic surgery of its kind in Saudi Arabia to treat a patient with colon cancer.
Dr. Haytham Sumrien, a consultant laparoscopic and robotic colorectal surgeon at JHAH, used subileal dissection to conduct a right hemicolectomy, whereby the right side of the colon and part of the small intestine are removed, and the remaining section of the colon is attached to the small intestine.
Colorectal cancer is the third most deadly and fourth most common cancer in the world. Traditional surgery for a right hemicolectomy involves making a large cut to the abdomen through the belly button, which can cause pain for the patient and discomfort while they recover. It also creates a larger risk that the patient suffers from complications arising from open surgery.
“Using the robotic subileal approach is like opening the pages of a book one by one,” Dr. Sumrien explains. “You delicately unfold one layer of the bowel to get to the next layer, and so on, until you reach the tumor. It is significantly more precise, and causes much less damage, than open surgery or even traditional minimally invasive surgery for colon cancer.
“Robotic surgery allows for more flexibility when treating locally advanced tumors. Also, we can go through the bikini line using a cut of less than 5 cm to remove even large tumors. This cut is horizontal to the body, rather than vertical, which minimizes pain and the chances that a patient develops hernias.
A smaller cut also means a patient will be at lower risk of infection and should have a significantly shorter stay in hospital. This is particularly true for overweight and obese patients, because we don’t have to cut through a thick layer of fat
Munira, the first JHAH patient to undergo a right hemicolectomy using the robotic subileal approach, spent just two and a half days in hospital before she was discharged.
“I don’t experience pain any longer, I’m back to my usual activities, and I’m eating and drinking normally,” she says. “Previously, I couldn’t eat properly because the cancer was causing an obstruction.”
Munira, 76, says she is “most excited about Hajj — I didn’t think I’d be able to make the pilgrimage before I had surgery.”
With a right hemicolectomy using the subileal approach, robotic tools are introduced to the body through five “ports” — tiny incisions — in the belly. Among the tools is a high-definition camera that gives the surgeon a three-dimensional view from inside the bowel.
Once the right side of the colon has been removed, the dexterity of the robotic tools allows the surgeon to connect the small intestine to the remaining part of the large intestine from inside the body. With traditional surgery, the two organs are connected with the bowels outside the body.
“The robotic approach, and joining the bowel from inside the abdomen, allows the patient to recover faster,” Dr. Sumrien says. “It also reduces the risk of a condition called ileus, which can cause severe pain, vomiting, and other unwanted side-effects.”