Facing Surgery for. Learn about minimally invasive da Vinci Surgery

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1 Facing Surgery for Colorectal Cancer? Learn about minimally invasive da Vinci Surgery

2 The Condition: Colorectal Cancer The colon and rectum are part of your large intestine. Their main function is to pass solid waste from your body. Colorectal cancer usually starts in the glands of the colon or rectum lining. Almost all cases of colorectal cancer begin as non-cancerous (benign) polyps that slowly develop into cancer. 1 Like many cancers, colorectal cancer can spread to lymph nodes or other organs. Colorectal cancer symptoms may include: blood in your stool, changes in bowel habits, pelvic pain, narrow stools, and unexplained weight loss. Colorectal cancer affects nearly 1.3 million people worldwide each year and is the fourth most common cause of cancer death. 2 Colorectal cancer is more common in men, people over age 60, and in developed countries. 1,2 Transverse Colon Ascending Colon Descending Colon Rectum The Intestinal Tract Sigmoid Colon

3 The Surgery: Colorectal Surgery If you are facing colon cancer, your doctor may recommend a colectomy. During a colectomy, part or all of your colon will be removed, depending on the extent of the cancer. For patients diagnosed with rectal cancer, surgeons typically perform a low anterior resection (LAR) to connect the rectum to the colon after removing the cancer. If the cancer is too close to the anus, your surgeon may need to remove your rectum, anus and part of your sigmoid colon. This is known as an abdominoperineal resection or APR. Colorectal procedures are often performed using traditional open surgery, meaning a large open incision is made from your pubic bone to just below your breastbone. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your body. Open surgery allows doctors to see and touch your organs as they operate.

4 Laparoscopic surgery is a minimally invasive alternative to open surgery. With laparoscopy, your surgeon operates through a few small incisions using special instruments, including a tiny camera. The camera sends images to a video monitor in the operating room to guide doctors during the operation. There is another minimally invasive surgical option for patients facing colorectal surgery: state-of-the-art da Vinci Surgery. Open Surgery Incision da Vinci Surgery/ Laparoscopy Incisions

5 da Vinci Surgery: A Minimally Invasive Surgical Option Using the da Vinci System, your surgeon makes a few small incisions - similar to traditional laparoscopy. da Vinci features a magnified 3D HD vision system and tiny instruments that rotate far greater than the human wrist. These features enable surgeons to operate with enhanced vision, precision, dexterity and control. Colon Cancer: As a result of da Vinci technology, da Vinci Colectomy offers the following potential benefits: Precise removal of cancerous tissue 3 Low blood loss 3,4 & low rate of complications 3,4,5 Quick return of bowel function & normal diet 4,5 Low conversion rate to open surgery 4,5 Short hospital stay 3,4,5 Small incisions for minimal scarring Rectal Cancer: da Vinci Low Anterior Resection offers precise removal of cancerous tissue, 6 as well as the following potential benefits compared to open surgery: Less blood loss 7 Less pain 8 Shorter hospital stay & faster recovery 8 Quicker return of bowel function & normal diet 8 Small incisions for minimal scarring Rectal Cancer: Compared to traditional laparoscopy, da Vinci Low Anterior Resection offers the following potential benefits: Lower conversion rate to open surgery 9 Fewer major complications 9 Shorter hospital stay 9 Quicker return to normal diet 9 Quicker return of urinary & sexual function 10

6 Risks & Considerations Related to da Vinci Colectomy & Low Anterior Resection: Potential risks of any colectomy and low anterior resection procedure include: intestinal fluid leakage, internal bleeding, blockage in the intestine, blocked artery in the lung, abscess, urinary problems, injury to surrounding organs, and wound infections. 3,8 Important Information for Patients: All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risks specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to other surgical techniques; the need for additional or larger incision sites; a longer operation or longer time under anesthesia than your surgeon originally predicts. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to davincisurgery.com/safety. All people depicted unless otherwise noted are models Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, da Vinci Si, Single-Site, TilePro, FireFly, Skills Simulator, EndoWrist and EndoWrist One are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders. PN Rev F 07/2013

7 Your doctor is one of a growing number of surgeons worldwide offering da Vinci Surgery. For more information and to find a da Vinci surgeon near you, visit: 1 Available from: 2 Available from: 3 Patel CB, et al. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. Dis Colon Rectum Feb;54(2): D Annibale A, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum Dec;47(12): Spinoglio G, et al. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum Nov;51(11): Epub 2008 May Hellan M, et al. Short-term outcomes after roboticassisted total mesorectal excision for rectal cancer. Ann Surg Oncol Nov;14(11): Epub 2007 Sep 1. 7 desouza AL, et al. A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma. Dis Colon Rectum Mar;54(3): Park JS, et al. S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc Jan;25(1): Epub 2010 Jun Baik SH, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol Jun;16(6): Epub 2009 Mar Kim JY, et al. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol Aug;19(8): Epub 2012 Mar 21.

8 The Enabling Technology: da Vinci Surgical System The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including highdefinition 3D vision and a magnified view. Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. Though it is often called a robot, da Vinci cannot act on its own. Surgery is performed entirely by your doctor. Together, da Vinci technology allows your doctor to perform routine and complex procedures through just a few small openings, similar to traditional laparoscopy. The da Vinci System has been used successfully worldwide in approximately 1.5 million various surgical procedures to date. da Vinci - changing the experience of surgery for people around the world.