Laparoscopic surgery has become the standard of care at many national centers such as the Cleveland Clinic and Mayo Clinic. While laparoscopic surgery has become the accepted standard treatment for gallbladder problems in the Northwest, most colo-rectal surgeons have limited experience with laparoscopic surgery. At the Institute for Laparoscopic Surgery we are currently recommending a laparoscopic approach for almost all colon surgeries based on our personal experience and the medical evidence. If you have seen a surgeon who recommended open colo-rectal surgery rather than laparoscopic we suggest that you obtain a second opinion with us, either in person or by phone.
Q. What is the difference between standard colon surgery and laparoscopic colon surgery?
A. The operations are essentially the same, except that in standard colon surgery a single long mid-line incision is made to allow the surgeon and assistant to place both their hands in the abdomen and view the operation directly. In laparoscopic colon surgery, there are much smaller incisions. We generally make four or five small incisions approximately -inch orless through which the surgeon and assistant work using a long video camera called a laparoscope and specialized instruments. Towards the end of the laparoscopic procedure, one of these incisions is lengthened to less than 2 inches to allow removal of a piece of colon and let us reconnect the two ends of the intestine, the anastomosis. These smaller incisions result in less postoperative pain, faster recovery time, and smaller scars as compared to the standard open operation.
Q. What is hand-assisted laparoscopic surgery? Is it as good as laparoscopic surgery?
A.Hand-assisted laparoscopic surgery involves making a three or four inch incision along with the other standard laparoscopic incisions to allow the surgeon to place an arm and hand in the patients abdomen during surgery. Some surgeons without laparoscopic experience are using this technique as a "bridge" to learning the laparoscopic technique, while others feel that it offers equivalent benefit to patients compared to a laparoscopic approach. At the Institute for Laparoscopic Surgery, we believe that a true laparoscopic approach offers significantly more benefit to patients than a hand-assisted approach. We only use the hand-assisted technique in cases where we would otherwise convert to an open operation.
Q. What are the advantages of a laparoscopic approach?
A. The advantages are less pain after surgery, faster return to normal activity, and smaller scars.These have been demonstrated in multiple studies published in respected medical journals. Additionally, research into the effects of laparoscopy show that there is less immune suppression after laparoscopic surgery compared to standard open surgery, which may translate into fewer complications after surgery. Studies also suggest a lower rate of intra-abdominal adhesions after laparoscopic surgery as compared to standard open surgery, which may result in a lower risk for post operative bowel obstruction.
Q. What can I expect if I have laparoscopic colon surgery?
A. Prior to surgery, you will be placed on clear liquids for two days, and receive a bowel prep to remove solid material from the colon. Patients are usually admitted to the hospital on the morning of surgery. You will receive a general anesthetic during your surgery. How long the surgery takes will depend on how
much of the colon is removed. The operation usually takes from under one hour to as long as three hours. Recovery periods also vary, but most patients are walking in the hallway the day after surgery and begin taking liquids by mouth by the second day after surgery. You will be ready to go home when you are passing flatus (passing gas through the rectum) and taking all medications by mouth. This usually occurs by the third or fourth postoperative day, though often happens after only one or two days following surgery. When you leave the hospital, your only restriction is to refrain from lifting heavy objects for one month after the day of surgery.
Q. Is laparoscopy always successful?
A. In my personal experience, we have completed the operation laparoscopically approximately 90% of the time. The other 10% of the time, we have converted to an open operation for a variety of reasons, primarily related to the size of the patient or the size of the colon.
Q. Are there complications of laparoscopic colon surgery?
A. The laparoscopic approach contains all the same risks of complications as the standard open approach, including bleeding, post operative infection, possible injury to adjacent organs, complications related to the anastomosis, and complications related to the incisions. The risk of the complications is not related to whether the procedure is done laparoscopically or open, but rather to the care and experience of the surgeon performing the procedure.
Q. If I have had previous abdominal surgery, can I still have laparoscopic surgery?
A. Yes, absolutely.
Q. Is laparoscopic surgery possible for patients with Crohns disease or ulcerative colitis? Has it been shown to be safe?
A. Yes. We have performed laparoscopic small bowel and large bowel resections, and laparoscopic total proctocolectomy with J-pouch reconstruction for patients with inflammatory bowel disease. Institutions such as the Mayo Clinic and Cleveland Clinic have published their series in surgery journals showing that laparoscopic surgery is safe and effective for inflammatory bowel disease.
Q. Is laparoscopic colon surgery a good idea if I have colon cancer?
A. Yes. Up until 2004, this had been a controversial area of laparoscopic colon surgery. Many surgeons have elected not to offer laparoscopic colon surgery to patients with cancer, citing concern regarding adequate lymph node removal, case reports in the surgical literature of tumor recurrence at the incisions, and concern that laparoscopic colon resection may not lead to a cure rate for colon cancer comparable to standard open surgery. However, it has now been proven that laparoscopic colon surgery results in equal, if not better cure rates for cancer patients when performed by a surgeon with adequate experience in the laparoscopic technique. Studies published by experienced laparoscopic colon surgeons have shown no increased incidence of tumor recurrence at the incisions compared to studies of standard open operations. As well, laparoscopic surgery offers the colon cancer patient advantages in cancer care of improved staging, better palliation for advanced tumors, and potentially less immune suppression in the post operative period.
In summary, laparoscopic colectomy is a superior alternative to open colon surgery when performed by surgeons with expertise and experience in both laparoscopic and colorectal surgery.
Q. If laparoscopic surgery is so good, why arent all surgeons doing it?
A. Many established colo-rectal surgeons have limited experience with laparoscopic surgery and are uncomfortable offering laparoscopic surgery to their patients. If you have not been offered a laparoscopic option for your operation, we suggest that you obtain a second opinion with a surgeon with experience in laparoscopic colo-rectal surgery.
Dr. David Lauter, who started the Institute for Laparoscopic Surgery, was an investigating surgeon in the National Cancer Institute study of laparoscopic colectomy published in 2004 which demonstrated the benefits of laparoscopic colectomy.
If you have further questions regarding laparoscopic surgery, phone our offices at (425) 453-7888 to schedule a discussion.
