LAPAROSCOPIC COLORECTAL SURGERY
(Excerpted from Society of American Gastrointestinal Endoscopic Surgeons' Task Force on Patient Information)
- Basics: The Colon
- Conventional (Open) Colon Surgery
- Minimally Invasive (Laparoscopic) Colon Surgery
- Who is a Candidate for Laparoscopic Colon Resection?
- How is Laparoscopic Colon Resection Performed?
- Advantages of Laparoscopic Colon Resection
- What Complications Can Occur?
- What Happens if the Operation cannot be Performed or Completed by the Laparoscopic Method?
Basics: The Colon
The colon is the large intestine-- the lower part of your digestive tract. The intestine is a long, tubular organ made up of the a) small intestine, b) the colon (large intestine) and c) the rectum, which is the last part of the colon. After food is swallowed, digestion begins in the stomach, and then continues in the small intestine, where the nutritional part of the food is absorbed. Waste products move pass into the colon to the rectum and are then expelled from the body.Conventional (Open) Colon Surgery
Each year, more than 600,000 surgical procedures are performed in the United States to treat a number of colon diseases. Diseases of the colon and rectum that might requiring surgical intervention include diverticulitis, ulcerative colitis, Crohn's colitis, colonic polyps not amenable to removal by colonoscopy, tumors (benign and malignant), hemorrhage, as well as other entities.
Patients undergoing colon surgery often face a long and difficult recovery because the traditional "open" procedures are highly invasive. Most open surgeries of the colon require long incisions, and surgery results in an average hospital stay of 5-8 days and usually requires 6 weeks for recovery.
Minimally Invasive (Laparoscopic) Colon Surgery
Laparoscopic colon surgery is a new technique that is rapidly gaining popularity. Advantages of laparoscopy over the open method of surgery include the following:- Colon function normalizes faster
- Faster recovery time and shorter hospitalization
- Less postoperative pain
- Quicker return to normal activities
- Smaller scar
Laparoscopic colon surgery was introduced approximately 12 years ago. Yet, only 3% of all colon resections are performed this way in the United States. Explanations for this may include, surgeon resistance to accepting this procedure as comparable to traditional operations; lack of surgeon experience with minimally invasive techniques; that laparoscopic colon surgery is an advanced procedure that takes a long period of time to master. The surgeon makes about four or five small one-half inch long incisions. A laparoscope (a tiny telescope attached to a video camera) is inserted into one of the openings, allowing the surgeon to see inside the abdomen. Instruments are inserted through the other openings and are used to remove the diseased section of bowel and reattach the healthy segments ('end-to-end anastomosis'). A slightly larger incision is usually made to remove the diseased section of colon from the body. The surgery takes 2 to 3 hours. The patient is frequently out of the operating room more quickly than after an open procedure, and there is no large incision to suture.
Who is a Candidate for Laparoscopic Colon Resection?
Laparoscopic colorectal surgery is infrequently performed in the United States. Not because patients are inadequate candidates, but because many surgeons do not perform these operations. Many patient factors that previously were considered absolute contraindications to laparoscopy are now relative contraindications, and with increasing surgical experience, and improved minimally invasive technology, laparoscopic colorectal surgery may be offered to a great many patients with a variety of colorectal diseases, including colon cancer.
How is Laparoscopic Colon Resection Performed?
"Laparoscopic" and "open" colon surgery simply describe the techniques a surgeon uses to gain access to the internal surgery site.Most laparoscopic colon procedures start the same way. Using a 'canula' (a narrow tube-like instrument), the surgeon enters the abdomen. A 'laparoscope' (a tiny telescope connected to a video camera) is inserted through the canula, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Several other canulas are inserted to allow the surgeon to work inside and remove part of the colon. The entire procedure may be completed through the canulas or by lengthening one of the small canula incisions.
Advantages of Laparoscopic Colon Resection
Results may vary depending upon the type of procedure and patient's overall condition. Common advantages are:- Less postoperative pain
- May shorten hospital stay
- May result in a faster return to solid-food diet
- May result in a quicker return of bowel function
- Quicker return to normal activity
- Better cosmetic results
What Complications Can Occur?
As with any operation, there is the risk of a complication. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.Slight risk:
- Bleeding or infection (present with any operation) Even smaller risk:
- A leak where the colon was connected back together.
- Injury to adjacent organs such as the small intestine, ureter, or bladder
- Blood clots to the lungs.