Robotic Surgery

Robotic surgery is just one of my many specialties here at Anna Toker, MD in Mansfield,

Texas. This procedure is a minimally invasive robotic resectioning of benign or

malignant colon diseases. Furthermore, it lessens painful reactions and complications,

shortens hospital stays, and speeds up recovery.

Through robotic surgery, I helped USMD Arlington Hospital become one of the Top 10%

Hospitals for Colorectal Surgery Length of Stay. Now, I bring these skills to Methodist

Mansfield Medical Center, Charlton Methodist Hospital, and Midlothian Methodist Medical Center

• As a reminder prior to major surgery, please avoid over the counter blood thinners, such as aspirin, unless directed to stay on them by the doctor.
• We do want you to continue to take your regular medications prior to the procedure with some exceptions. Diabetic medications will need to be altered during the period of fasting prior to the surgery. Blood thinning medicines may need to be changed as well- please contact the doctor to discuss the best course of action for these 2 issues if they apply to you.

• Proper nutrition is critical to healing and so from now until your surgery, please follow the link below to online purchase your enhanced recovery pack which will be mailed to you:
• 2 weeks prior to surgery and 4 weeks after surgery, you should be on a milk-free, gluten-free, and egg-free diet as well as:
• 1) avoid sugar, high fructose corn syrup, processed food, alcohol consumption and cigarette smoking. Use Stevia as a sweetener when possible.
• 2) You should be consuming at least 70 grams of protein per day, 
• 3) You should be consuming 64 ounces of water daily unless you are on a water restricted diet by your physician.
• 4) take Restore 1 capsule daily 30 minutes before a meal
• 5) take one HL5 collagen packet per day
• 6) take a Sunrise packet every morning and 3 sunset capsules nightly
• 7) take the Nitro sublingual tincture 3 times daily throughout the day

• I suggest the following supplements to improve intestinal health and promote healing intestinal surgery- (NOW foods is a good source - available online, at health food stores and on Amazon)
• 1) N AcetylCysteine (NAC) 600 mg
• 2) L-Glutamine 500 mg- an amino acid that supports GI nutritional health

• The day before your surgery you will start a clear liquid diet and drink one dose of magnesium citrate at noon. (If you can not find Magnesium Citrate, you can take Miralax until you have had 1 BM-do not need to be clear) If you are having a colon resection, antibiotics have been called out to your pharmacy (metronidazole) to take in 2 separate doses the evening before surgery- follow the instructions on the prescription. I do not typically call these drugs out for hernia or perineal surgeries.
• You will be on a clear liquid diet until 6 hours prior to surgery. To make sure your body has a good energy supply during the surgery, you should drink an 8 ounces of isopure protein or gatorade clear protein drink at bedtime and then at 6 hours before surgery. You will need to have an empty stomach for 6 hours prior to surgery.
• The hospital will contact you for a pre-operative assessment which will be done several days prior to surgery. Labs may be drawn based on the anesthesiologist recommendations. They will also give you suggestions for an antiseptic soap to use prior to surgery and when to use it.
• We will work with your insurance to ensure there is prior approval if time allows (some emergency surgeries do not allow enough time for this process). Both our office and the hospital will alert yo u to your financial responsibility based on your insurance contract.

Most patients undergoing robotic colon surgery are in the hospital 2-4 days. If we are worried about your mobility after surgery, we can coordinate home health to visit after surgery to track your progress. 

Pain management after surgery will avoid narcotic medications as studies have shown that narcotics worsen outcomes. But, we want to make sure your pain is managable, so we suggest the following:

1) Prescriptions will be written for a muscle relaxant (Cyclobenzaprine), an anti-inflammatory(ketorolac or celecoxib (unless contraindicated)), and a medication for neuropathy nerve pain (Gabapentin) which has been shown to augment the effect of the other medications.

2) over the counter medication, tylenol, can be used as directed on the bottle

3) holistic and herbal supplements can be used as well including- 

• arnica montana, quercetin, and zinc (prevent bruising)
• Turmeric (anti-inflammatory)
• Boswellia (anti-inflammatory)
• CBD oil supplements (anti-anxiety, anti-inflammatory)
• For any urgent issues call 214-942-3740.
• Remember, patients do best with surgery when they are hydrated, relaxed, and have proper nutritional intake. Get some rest, eat well, and we will see you the morning of your surgery.

There is an exciting new technology to consider for pain, stress, immunity/blood flow and sleep that does not involve medication and that does not need a prescription. It is called Superpatch and it uses a tactile code on the skin to neutralize certain neurologic communication controlling pain, your stress response, and even sleeplessness. These 4 issues after surgery can be the difference between healing and struggling after an operation. It can be used on anyone at any age and does not interact with medication. It is safe for any age group and even in pregnancy. If you hate pills, these unmedicated technology pathches are an amazing solution. This can not replace proper nutrition, but is designed to replace medications. 

• The REM sleep patch is applied at bedtime- anywhere on your skin- it will not make you feel sleepy, just apply when you want to sleep and then lay down to sleep. Remove the patch in the morning.
• The Peace patch for stress can be placed anywhere on the skin and stays 24 hours at a time and then is changed daily.
• The Freedom pain patch should be applied as close to your incisional pain as possible (after robotic surgery, my patients complain more about the right lower quadrant incision that any other, so if unsure, place it there). This patch can work within 15 minutes when applied properly but may take several days to maximize results, but studies show patients use 80% less pain medications by day 4 with this patch
• The Defend patch improves blood flow and immunity, critical components to healing an operation and preventing illness in the pre and post-operative timeframe. Wear 24 hours a day, change the patch daily