Robotic Surgery

How is it performed?

• You are fully asleep under general anesthesia. Depending on the operation, the instruments and camera go in through 3 to 6 small cuts, each about 1 cm long.
• Dr. Ahmed controls the instruments from the console, looking at a magnified, high-definition 3D view of the inside of your abdomen.
• The instruments bend and turn like a human wrist, and the system filters out the natural tremor of the hand. This makes fine stitching, and work in deep, narrow spaces, more precise.
• A surgical assistant and the operating team stay beside you throughout the operation.

What are the benefits?

Compared with open surgery, robotic surgery means smaller cuts, less pain, less blood loss, a shorter hospital stay, and a faster return to daily life. Compared with standard keyhole (laparoscopic) surgery, the results of simpler operations are often similar. The robot helps most in difficult situations:

• Deep, narrow spaces, such as the pelvis in rectal cancer surgery or the area around the food pipe in hiatal hernia repair.
• Fine stitching inside the body, such as the joins in SADI-S and gastric bypass, and closing the gap in a hernia.
• Repeat operations, where scar tissue from earlier surgery must be separated carefully.
• A very high BMI, where a thick abdominal wall makes standard keyhole instruments harder to control.
• Large or recurrent hernias, where the mesh is placed between the layers of the abdominal wall.

Operations Dr. Ahmed performs robotically

Cancer surgery

Robotic cancer surgery follows the same principles as open surgery: the tumor is removed completely, with a margin of healthy tissue and the lymph nodes that drain it, so it can be staged and treated properly.

• Stomach cancer: removal of part or all of the stomach (gastrectomy) with its lymph nodes.
• Colon cancer: removal of the affected part of the colon (colectomy) with its lymph nodes.
• Rectal cancer: removal of the rectum with the fatty tissue around it (total mesorectal excision), deep in the pelvis. The clear, magnified view helps protect the nerves that control the bladder and sexual function and, when the tumor’s position allows, keep the muscle ring of the anus, so you do not need a permanent stoma (bag).
• Other tumors: gastrointestinal stromal tumors (GIST) and other selected tumors of the stomach and small intestine.

Your plan, including any chemotherapy or radiotherapy before or after surgery, is made together with your oncologist.

Weight-loss surgery, especially SADI-S

Subject to Dr. Ahmed’s diagnosis, SADI-S, sleeve gastrectomy with his Identical Sleeve technique, Roux-en-Y gastric bypass, one-anastomosis gastric bypass (OAGB), and revisional surgery may be performed robotically. The robot helps most with SADI-S, whose key join is made deep in the upper abdomen, and with revisional surgery, where scar tissue must be separated carefully. Every robotic weight-loss operation comes with our Fast Track program.

Full details are on the Bariatric Surgery page.

Ventral and incisional hernia repair

A ventral hernia is a bulge through a weak spot in the front of the abdomen: at the belly button (umbilical hernia), above it (epigastric hernia), or through the scar of an earlier operation (incisional hernia).

• Dr. Ahmed closes the gap in the muscle with stitches and places the mesh between the layers of the abdominal wall, away from the bowel. This is called the eTEP technique (enhanced-view totally extraperitoneal).
• This usually needs fewer fixing tacks, which can mean less pain after surgery.
• For large or recurrent hernias, the robot allows abdominal wall reconstruction: the muscle layers are released and moved to close wide gaps, without a long open cut.

Groin (inguinal) hernia repair

An inguinal hernia is a bulge in the groin, and it is much more common in men.

• The mesh is placed from the inside, behind the groin muscles, through 3 small cuts. Dr. Ahmed uses both main techniques, TAPP (through the abdomen) and TEP (outside the lining of the abdomen), and chooses the one that suits your hernia.
• Hernias on both sides can be repaired through the same cuts.
• The inside view makes it well suited to hernias that came back after an open repair.
• Most patients go home the same day or the next morning.

Hiatal hernia and reflux surgery

A hiatal hernia is when part of the stomach slides up through the diaphragm into the chest, often causing heartburn. Dr. Ahmed repairs the opening in the diaphragm with stitches and, to stop the reflux, wraps the top of the stomach around the lower food pipe (fundoplication). The magnified view helps in this narrow space, especially with large (paraesophageal) hernias.

Who is it for?

Most patients who can have keyhole surgery can have robotic surgery. It may suit you especially if:

• You need cancer surgery, particularly for rectal or stomach cancer.
• You need SADI-S or revisional weight-loss surgery.
• Your BMI is very high.
• You have a large or recurrent hernia, or hernias on both sides.
• You have had abdominal surgery before.

Robotic surgery may not suit you if your heart or lungs cannot safely cope with general anesthesia and the gas used to inflate the abdomen during keyhole surgery. At your consultation, Dr. Ahmed will tell you whether robotic, standard keyhole, or open surgery is best for you.

Before surgery

• Everyone has blood tests and a visit with the anesthesia doctor. Other tests depend on your operation: scans and an endoscopy (a camera test) to plan cancer surgery, and the full check-up described on each weight-loss page.
• If you smoke, stop at least 4 to 6 weeks before surgery. Smoking slows healing and raises the risk of problems.
• Tell us about all your medicines, especially for diabetes, blood pressure, and blood thinning. Some will need adjusting.
• Your operation takes place at Cleopatra Hospitals, and we explain every step to you in advance.

Recovery and follow-up

How long you stay in hospital depends on the operation:

• Groin hernia: usually home the same day or the next morning.
• Ventral hernia: usually one night, or 2 to 3 nights after abdominal wall reconstruction.
• Weight-loss surgery, including SADI-S: usually one night.
• Hiatal hernia and reflux surgery: usually one night.
• Cancer surgery: usually 3 to 7 nights, depending on the operation.

After you go home:

• You get out of bed within a few hours of most operations. Moving early lowers the risk of blood clots.
• Return to work depends on the operation: often within a week after hernia repair, and after a few weeks after cancer surgery. Heavy lifting usually waits 2 to 6 weeks; we will tell you exactly when.
• After cancer surgery, we go through the lab report on the removed tissue (pathology) with you and plan any further treatment with your oncologist.
• After weight-loss surgery, your diet, vitamins, and follow-up visits follow the plan on that operation’s page.
• Follow-up visits are in the clinic or by video consultation.

What are the risks?

Robotic surgery carries the same main risks as the same operation done by standard keyhole surgery, and we will explain yours at your consultation. The main risks are:

• Bleeding or wound infection.
• Injury to nearby organs, such as the bowel, bladder, or blood vessels. This is rare.
• Blood clots in the legs or lungs. Walking early and blood-thinning injections lower this risk.
• A hernia at one of the small cuts. This is uncommon.
• Rarely, changing to standard keyhole or open surgery during the operation, when that is safer for you. This is a safety decision, not a failure.
• For some operations, a longer time under anesthesia than with standard keyhole surgery, mainly to set up the robot.

Risks that belong to each operation, such as a leak after weight-loss surgery or a hernia coming back, are explained on that operation’s page.