LAPAROSCOPIC COLORECTAL SURGERY
Laparoscopic or minimally invasive surgery has revolutionized many surgical procedures and has spread to many fields including orthopedic surgery, spine surgery, gynecological surgery and general abdominal surgery.
Colorectal surgery can be performed with the laparoscopic or minimally-invasive technique with substantial reductions in complications, pain, narcotics use, hospital stay, and postoperative recovery time.
Minimally-invasive techniques allow the colorectal surgeon to remove benign polyps, malignant tumors, diverticular disease and inflammatory bowel disease in any or all parts of the colon or rectum.
Benign versus malignant cases
In the past, a concern existed that colorectal cancers should be removed with an open standard technique, sometimes known as a laparotomy. Gradually, however, the improvements in technique and the technical advancements led to more and more of these common colorectal surgical cancer cases being performed with the laparoscopy. In the largest studies to date, this technique appears equally safe and effective without any increased risks of complications or tumor cell spread, as long as it is done by an experienced surgeon with advanced training in laparoscopic colorectal surgery.
When I completed my colorectal surgical fellowship back in 2000, the tide was just turning on this topic. Today, in the hands of an experienced laparoscopic colorectal surgeon, laparoscopic colectomy for cancer is a widely accepted and appropriate choice for many people.
Advantages of laparoscopic colectomy
The advantages of a laparoscopic colorectal resection are similar to the advantages of any minimally-invasive procedure. Statistically there is less blood loss, less postoperative pain, less use of narcotics, less hernia formation from the wounds, and less strain on the heart on the lungs. Perhaps more important for most people, laparoscopic colorectal resections result in a much reduced recovery time after one leaves the hospital. In my clinic, one of the most striking changes over the years has been to see the vigor and fitness of my patients after they have undergone a laparoscopic colectomy. Within a few weeks, most of them are getting out, going back to work and resuming activities, whereas in the days of open colectomy procedures, most patients do not hit these recovery milestones until six or eight or ten weeks postoperatively.
Disadvantages of laparoscopic colectomy
The initial concern that surgical manipulation with the laparoscopy might somehow spread cancer cells to the incisions, wounds or other tissues, has been debunked by a number of large multicenter studies. Nonetheless, it is believed that such problems can occur with any kind of cancer surgery whether the technique is open or laparoscopic, and a novice laparoscopic colon surgeon may be more apt to manipulate the tumor aggressively and result in some shedding or spread of these malignant cells. So finding an experienced laparoscopic colorectal surgeon is of critical importance if the procedure is being done for a malignant tumor or colorectal cancer.
Experienced surgeons and high volume teams create success
In keeping with that recommendation, I would reinforce the notion of surgeon experience for this type of procedure as being very important because the procedure is highly technical and presents many surgical challenges. The more experienced the surgeon, the shorter the operative time and the lower the complication rate. At our center, for example, most laparoscopic colorectal surgical procedures are performed in a timeframe that is shorter than the usual timeframe for a comparable open procedure. Nearly all of the laparoscopic colectomy procedures are performed in a total of between 40 and 90 minutes. While speed is not the most important goal, it indicates a systematized operative approach in which an experienced surgeon and operating room crew have established instruments and systems for conducting the procedure smoothly, efficiently and safely.
In experienced hands, there is absolutely no difference in the oncologic success, the margin of resection, the number of lymph nodes harvested, or the security, safety and integrity of the surgery and the anastomosis (this is the connection between the two ends of the colon after the specimen has been removed).
The emerging standard of care
In time, as more and more surgeons undergo the rigorous training required to become expert laparoscopic colorectal surgeons, and as patients and referring doctors increasingly demand the advantages that come along with the minimally invasive technique, we will see laparoscopic colorectal surgery become the standard of care for most cases.
Tags: colorectal surgery