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Cancer of the sigmoid loop is removed by a sigmoid colectomy. This page is about that robotic operation: how the artery is tied, where the new join sits and how it is tested, why the bowel is prepared with antibiotics, and when an open operation or a stent is the safer choice. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 10 October 2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
Shah’s Gastro, Cancer & Robotic Surgery Centre. Super-specialty training in surgical gastroenterology, two higher degrees in it, and 18 years of experience in GI and cancer surgery. Every colon cancer is discussed at the tumour board once staging is complete, and Dr Harsh Shah performs the operation himself.
In short
The sigmoid is the S-shaped last loop of the colon, just above the rectum. A cancer here is removed by a sigmoid colectomy: the loop comes out with the fatty fold that carries its artery and lymph nodes, and the main artery of the left colon is tied either at its origin or just below its first branch.
The new join sits low, at the top of the rectum inside the pelvis, and is made with a circular stapler passed from below. A leak at this join is the risk everyone plans around: bowel preparation with antibiotics, a join that is not stretched, a blood-supply check with dye and a test of the join all aim at it.
Not every sigmoid cancer goes to the robot. A bowel that is already blocked or has burst, a bulky tumour stuck to the bladder or other organs, or an abdomen scarred by earlier operations is usually handled by open surgery or a stent, as described below.
The sigmoid loop ends where the rectum begins, and the two are treated differently. A tumour measured more than fifteen centimetres from the anal opening on a rigid scope, and above the fold of the abdominal lining, is treated as a sigmoid colon cancer. Lower than that, the rectal cancer pathway applies.
| Where the tumour sits | Which pathway | Where it is explained |
|---|---|---|
| Sigmoid loop, above the junction with the rectum | Colon cancer: operation first, then treatment by the pathology report | This page |
| Junction of the sigmoid and the rectum, or upper rectum | Rectal cancer: the MRI decides whether treatment comes before surgery | Robotic high anterior resection |
| Middle or lower rectum | Rectal cancer, operation chosen by tumour height | Which rectal operation by height |
The distinction matters because a rectal cancer may need radiotherapy or chemotherapy before the operation and is removed with a different technique. If your reports do not say clearly which side of the line the tumour lies, that is settled at the consultation, before any plan is made.
The sigmoid gets its blood from the inferior mesenteric artery, a branch of the aorta. In a high tie the artery is tied where it leaves the aorta; in a low tie it is tied just below its first branch, the left colic artery, which is kept. The protocol this centre follows allows either.
Either way the fatty fold of the sigmoid, with the lymph nodes that drain the tumour, is removed in one piece with its covering intact. That is the part of the operation that decides how accurately the cancer is staged, and the pathologist counts the lymph nodes; a count below the protocol’s minimum is itself treated as a high-risk feature.
The choice between a high and a low tie depends on your anatomy, the blood supply the remaining colon will rely on, and how far the colon must stretch to reach the join. It is the surgeon’s operative judgement and is explained to you before the operation. The vein that runs beside the artery is tied separately, higher up, near the lower border of the pancreas.
The bowel is divided well clear of the tumour on both sides, at least five centimetres away, and any organ the tumour is stuck to is removed with it in one block. Peeling a tumour off another organ risks leaving cancer behind, so it is never done.
The robot does not change what is removed. It changes how three delicate areas are handled: the root of the artery, where the nerves for bladder and sexual function cross; the plane behind the colon, where the left ureter lies; and the narrow pelvis, where the top of the rectum is divided and the join is made.
The robot gives no sense of touch, so a small tumour is found by the ink tattoo placed beside it at colonoscopy, and the margins are confirmed by sight and on the scans.
You lie on your back with the legs in padded supports, because the circular stapler for the join is passed from below. The table is tilted head-down and right side down, so the small bowel falls out of the pelvis. Small ports are placed across the abdomen, with the camera just above the navel.
The robot is docked from the side so that its arms reach the artery root and the pelvis first. If the bend of the colon near the spleen has to be freed, the arms are re-aimed towards the upper left abdomen; when that is expected, the port plan allows it without moving the robot.
The removed loop is placed in a bag and taken out through one short cut low across the abdomen, above the pubic bone. A low cut is less painful and less prone to a hernia than a cut through the middle.
The operation begins at the blood supply and finishes at the join: the nerves are found, the artery and vein are tied, the fatty fold is lifted in its natural plane, the colon is freed enough to reach, the bowel is divided with clear margins, and the two ends are joined and tested.
After a sigmoid colectomy the descending colon is joined to the top of the rectum, low in the pelvis. Most patients keep a normal route for stool and do not need a bag. The join is checked three ways before the abdomen is closed.
| Check | What it shows |
|---|---|
| The two rings of tissue cut out by the stapler | Both should be complete circles; an incomplete ring means the join is redone |
| Filling the rectum from below with the colon clamped above | Whether the join is airtight or leaks |
| Dye under the robot’s camera after joining | Whether both sides of the join have a good blood supply |
In a planned sigmoid operation a temporary stoma is seldom needed. It is added when the join is judged less secure: the blood supply is borderline, the patient is frail, or the bowel was blocked before surgery. A stoma nurse marks a possible site before every colon operation all the same, and if a stoma is a possibility it is part of your consent every time.
For a planned sigmoid operation the bowel is emptied the day before with a laxative preparation and antibiotic tablets taken together. The combination lowers both wound infection and leakage at the join; the laxative alone does not. Other preparation steps work on the same risks.
| Before surgery | Why |
|---|---|
| Bowel preparation with oral antibiotics, the day before | Fewer wound infections and fewer leaks at the join |
| Correcting anaemia, with iron into a vein if tablets fail or time is short | Better healing and fewer transfusions |
| Stopping smoking and alcohol at least four weeks before | Better healing of the join and the wound |
| Nutrition support if you have lost weight or eat poorly | Better healing; exercise preparation is added if you are malnourished or less active |
| A carbohydrate drink the evening before and a few hours before surgery | Less stress on the body; left out if the bowel is blocked or diabetes slows the stomach |
A leak usually shows itself between the third and seventh days: a fast pulse, fever, or abdominal pain that grows instead of settling, or a patient who was improving and goes backwards. It is never watched overnight. Feeding stops, fluids and antibiotics start, and a CT scan with contrast given from below is done the same day, with the surgeon informed at once. These risks, and the figures that apply to you, are discussed at the consent visit.
The robotic operation is planned for a prepared bowel. Many sigmoid cancers first come to light as a blockage or a burst bowel, and then the emergency pathway applies; a few planned cases are also better done open. Converting to open during an operation is a sound judgement, not a failure.
| Situation | What is done instead |
|---|---|
| Blocked bowel in a fit patient | Removal of the segment with a join, sometimes with a temporary stoma above it; or the end brought out as a stoma (Hartmann’s operation) if the patient is unstable or the abdomen contaminated |
| Blocked bowel in a frail patient, or with spread elsewhere | A stent placed through a scope to open the blockage, as a bridge to a planned operation or as the treatment in itself |
| Bowel blown up and tender, or burst | Same-day decision by the consultant surgeon; a burst bowel needs removal, a thorough washout and usually a stoma |
| Bulky tumour stuck to the bladder, womb or other organs | Tumour board discussion, then open removal of the tumour and the stuck organ in one block |
| Abdomen scarred by several earlier operations | Open surgery is often safer |
A blocked bowel cannot be emptied beforehand, which is one reason the planned robotic pathway does not apply. When a stent is used as a bridge, the approach for the later operation is decided again at the tumour board once you have recovered.
Keyhole surgery is the established standard for colon cancer, and robotic surgery is an accepted alternative in experienced hands. All three remove the same loop, the same fatty fold and the same lymph nodes. They differ in the cut, in how the pelvis and the artery root are seen, and in recovery.
| Open | Keyhole | Robotic | |
|---|---|---|---|
| Cut | A long cut down the middle | Ports and a short cut | Ports and a short low cut |
| View of the artery root and nerves | Direct | Magnified, two-dimensional | Magnified, three-dimensional, steady |
| Working in the narrow pelvis | Hands in a deep space | Straight instruments | Wristed instruments |
| Blood-supply check before joining | By eye | Dye where available | Dye built into the camera |
| Blood loss | Higher | Lower | Lower |
| Lymph nodes removed | The same | The same | The same |
| Hospital stay and return to work | Longest | Shorter | Shorter |
| Cost | Lowest | Moderate | Highest, for the robotic instruments |
When to return to work, to driving and to lifting depends on the job and on the cut, and is planned with you at discharge.
Recovery follows a set plan: up on the day of surgery, eating from the next day, no tube through the nose and usually no drain. Most patients go home around the fourth or fifth day after an uncomplicated operation.
| When | What happens |
|---|---|
| Day of surgery | Sitting out of bed a few hours after the operation; clear fluids; chewing gum; pain relief with minimal opioids |
| Next day | Normal food as tolerated; walking four times; urine catheter out; drip stopped |
| Second day | Full diet; pain tablets only; passing wind |
| Third day | A bowel action; a drain removed if one was placed; discharge checklist |
| Fourth or fifth day | Home once eating, walking alone, pain controlled on tablets and, if there is a stoma, able to change the bag |
Blood thinner injections continue for four weeks after a cancer operation, to prevent clots. Bloating with vomiting may mean a slow bowel; pain in the flank or very little urine is checked for a ureter problem.
The report is discussed about two weeks after the operation. It gives the lymph nodes examined, the margins, the mismatch-repair result and any high-risk feature, and those four items decide whether chemotherapy is advised. If it is, it starts within six to eight weeks of surgery.
| What the report shows | Usual advice |
|---|---|
| Stage I | No further treatment; follow-up only |
| Stage II without a high-risk feature | Follow-up only |
| Stage II with a mismatch-repair defect | Follow-up only; single-drug chemotherapy is not given |
| Stage II with a high-risk feature | Chemotherapy discussed and decided with you |
| Stage III | Chemotherapy, for three or six months depending on the nodes and the tumour |
★★★★★
“(Translated by Google) Dr. Harsh Shah's personality is very nice. He always talks in a good way. He has undergone surgery for colon cancer. Without any problem. Yours faithfully.🙏 (Original) ડૉ હર્ષ શાહ નો સ્વાભાવ ખૂબ જ સરસ છે.તેઓ હમેશા સારી રીત વાત કરે છે .મોટા આંતરડા ના કેન્સર ની સર્જરી એમને કરેલ લી છે. કોઈ પ્રકાર ની તકલીફ નાથી .આપનો અભર.🙏”
— Ismailbhai Shaikh, Google review, Gota clinic listing
★★★★★
“We came from Mp Indore for the treatment of Rectal cancer and Robotic surgery was done by Dr harsh shah....After surgery my son is good now. Heartly thankful to you sir...”
— Parasram Solanki, Google review, Google listing
★★★★★
“We consulted Dr. Harsh Shah for rectal cancer treatment and had a very good experience. He is a very experienced and knowledgeable doctor who explained the treatment process clearly and guided us at every step. His supportive nature and professional approach gave us confidence throughout the treatment. We are grateful for his dedication and the care provided by him and his team. Highly recommended for rectal cancer treatment in Ahmedabad.”
— Mamta Somar, Google review, Apollo Hospital, Bhat listing
Quoted exactly as written on the centre’s Google listings: a family whose relative had robotic surgery for colon cancer, and two patients of Dr Harsh Shah treated for other cancers, followed by a patient speaking after keyhole colon cancer surgery.
A robotic sigmoid colectomy costs more than an open or keyhole one, because of the robotic instruments and staplers. A temporary stoma and its later closure, a longer stay or a complication change the total. The office gives a written estimate once the plan is settled.
Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the office prepares the pre-authorisation papers; allow a day or two for robotic approval. Ask whether your policy covers robotic surgery and up to what limit. Bring the policy documents, photo identity, every report with the scans on disc, and a list of current medicines.
In a high tie the main artery of the left colon is tied where it leaves the aorta. In a low tie it is tied just below its first branch, which is kept. Both remove the lymph nodes of the sigmoid; the surgeon chooses for your anatomy.
Between the descending colon and the top of the rectum, low in the pelvis, using a circular stapler passed from below. It is tested before the abdomen is closed.
Because the two together lower both wound infection and leakage at the join. The laxative preparation alone does not.
Usually not after a planned sigmoid operation. A temporary stoma is added only if the join is judged less secure, and it is closed a few months later.
Usually not as an emergency. A blocked bowel is removed by an open operation in a fit patient, or opened first with a stent in a frail one.
A tumour more than fifteen centimetres from the anal opening on a rigid scope, and above the abdominal lining's fold, is sigmoid. Lower tumours follow the rectal cancer pathway.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 53 reviews
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for colon cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Send the colonoscopy, biopsy and CT reports ahead of your appointment, so the consultation starts with them already read. Which operation you need, and whether it is robotic, keyhole or open, is decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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