Bowel cancer, urology and plastic surgeons at NNUH join forces to perform complex robotic pelvic operation

A multi-disciplinary team of surgeons at NNUH have performed a major pelvic surgical procedure using robotic surgery.

Using robotic technology, the surgical team made up of Consultant Surgeons Irshad Shaikh (colorectal), Sandeep Kapur (colorectal), Omar Al Kadhi (Urology), Ms Anais Rosich-Medina and Richard Haywood (plastic and reconstructive) and anaesthetist Dr Bruce Fleming, performed what is called a pelvic exenteration operation for locally advanced rectal cancer. This involved removing the bladder, the lower bowel (rectum), anal canal, kidney tubes (ureters) and the prostate.

This is one of the most complex pelvic operations performed on colorectal cancer patients, with the aim of curing a patient of advanced rectal cancer. Urinary and colostomy bags are fitted and reconstruction of the pelvic floor was completed by the plastic surgical team.

We are one of the few hospitals across Europe to have carried out this procedure using Da Vinci Si robotic technology, which makes the procedure much less invasive. The NNUH surgeons took an additional innovative approach, which is believed to be a world first, with all surgeons working at the same time, including the plastic surgeons, who began preparation for reconstructive surgery whilst the colorectal and urology teams were removing the cancer robotically.

Patient Peter Fabb, 53, of Heveningham, was able to go home just seven days after undergoing this complex major robotic procedure. He had originally gone to his GP after feeling tired and having some discomfort whilst sitting down. Initially doctors thought it was an infection before cancer was identified and he was treated with chemo-radiotherapy in April – during the height of the Covid-19 pandemic.

Peter said: “I wasn’t really that worried about Covid as the cancer was a bigger challenge.

“After chemotherapy, I had my operation and was left with just a few small keyhole type incisions on the abdomen despite the extensive nature of the surgery. I spent seven days in hospital and I remember it being very hot on the ward and thinking that the nurses had a difficult job wearing masks on a long shift.”

Consultant Surgeon (Colorectal) Irshad Shaikh said: “Peter has already made significant progress since his operation. The robotic minimally invasive approach helped Peter to recover faster. With traditional open total pelvic exenteration and plastic surgical reconstruction surgery, patients would be in hospital on average for 14-21 days. This would include a period of time on the intensive care unit and be more invasive, requiring a large abdominal incision. Using this minimal invasive approach with the robotic platform, it was possible to minimise the impact of surgery and reduce the hospital stay to seven days and without the need for an intensive care stay or a large incision. The robotic platform gives 3D magnified views and helps in performing precision surgery.”

Mr Shaikh added: “Team work has enabled a significant step forward in patient care. Working synchronously we were also able to fully remove all Peter’s cancer while reducing the time Peter spent on the operating table. This enabled a quicker recovery and a reduced risk of complications, our new approach is a really exciting.

Consultant Urological Surgeon Omar Al Kadhi removed the bladder and prostate before performing a urinary diversion which involves using a segment of the small intestine to create a urinary stoma – which is connected outside the abdomen.

He said: “It takes a lot of planning and teamwork to deliver this type of complex surgery safely therefore only a handful of centres offer it to patients. We have demonstrated that in selected patients the robotic approach is feasible and may offer considerable benefits without compromising cancer outcomes. I am proud to be part of the team in Norwich that has made this possible.”

Consultant surgeon (Colorectal) Sandeep Kapur said: “I am delighted to be a part of this project, which shows what a committed team can achieve for the benefit of our patients.”

Consultant Plastic and Reconstructive Surgeon Anais Rosich-Medina, said: “Excellent team work was at the forefront of this extraordinary advancement in pelvic exenteration and reconstruction. This pioneering technique will undoubtedly benefit many more patients in the future.’

Fellow senior consultant plastics and reconstructive surgeon Richard Haywood added: “As reconstructive plastic surgeons we have modified and developed techniques over the last 15 years to ensure improved operating procedures and shorter operating times. Sometimes it means dodging Irshad or Sandeep’s sharp elbows.”

Theatres nursing clinical lead, Lisa Smith said: “The nursing team has worked hard to develop new skills, specifically learning and supporting new robotic technologies. To be part of the first and largest joint robotic pelvic operations is the icing on the cake and very exciting for the team and the future of our service.”

NNUH Chief of Surgery Division, Dr Tim Leary, praised the team’s work. “My sincere thanks go out to Irshad for his commitment and enthusiasm towards the ongoing development of Norwich as a robotic centre of excellence. He and the team should be very proud of all that they are achieving.”

NNUH Medical Director Professor Erika Denton said: “This is extraordinary progress for our patients and I am extremely proud of Irshad and his team who continue to strive for excellence in patient outcomes and in ensuring NNUH is at the forefront of use of this technology.”