Treatments

Minimally Invasive Surgery

Minimally invasive surgery refers to several techniques and technological advances that are all designed to minimize the physiologic impact of surgery, without sacrificing the results of surgery. Laparoscopic surgery is practically synonymous with the term minimally invasive surgery; however, minimally invasive surgeries include also robotic surgery and TAMIS. All of our surgeons are highly-trained laparoscopists and this is our preferred approach. We are also well versed in robotic surgery and TAMIS.

Laparoscopic Surgery

What is laparoscopic surgery?

Laparoscopic surgery is a specialized technique for performing surgery through smaller incisions. In traditional “open” surgery the surgeon uses a single, large incision to gain access to the abdomen and perform surgery. This incision must be large enough to allow both clear visualization of the operative field and allow adequate working space to perform the operation. Laparoscopic surgery allows for equivalent visualization and working space to be achieved via several small (0.5-1cm) incisions, known as “port-sites”. The key to this lies in a specialized camera mounted on a thin, tubular handle that allows the camera to be passed into the abdomen via a port site. The abdomen is filled with carbon dioxide providing working space and the live image of the abdominal compartment is projected to high-definition monitors in the operating suite. A wide array of specialized instruments can then be passed through additional port-sites to perform the operation.

A hybrid technique called “hand-assisted” laparoscopy may also be used if needed. This allows for a special port to be placed, through which the surgeon can insert a hand into the abdomen to assist with surgery. Although the incision required for the hand port is larger than the other laparoscopic incisions, it remains smaller than incisions employed in traditional open surgery. It is used for an added margin of safety and to help reduce the length of surgeries.

With proper training, most intestinal surgeries can be performed using the laparoscopic technique. There is a learning curve for laparoscopic surgery and it is estimated that at least 50 cases are needed to gain proficiency in this technique. All of our surgeons are highly-trained laparoscopists and this is our preferred approach.

What are the advantages to laparoscopic surgery?

• • less postoperative pain and reduction in need for pain medication

• • quicker return to tolerating a diet

• • shortened hospital stay

• • earlier return to daily activities

• improved cosmetic results

Is laparoscopic surgery safe?

Laparoscopic surgery is as safe as traditional open surgery and has been shown to be as effective as traditional open surgery, including for resection of cancer. The first step in deciding whether a laparoscopic approach is feasible will be made during pre-operative consultation – this will be based on your specific condition, the extent of disease and your past medical/surgical history. The final determination is made at the onset of surgery, upon entering the abdomen the surgeon will evaluate the abdominal cavity and determine if it is safe to proceed in a laparoscopic fashion. As with any intestinal surgery, certain risks related to anesthesia, bleeding, infection and bowel leaks (anastomotic breakdown) exist. These risks depend on your pre-operative health, the condition being treated and the specific operation being performed. An assessment and minimization of these risks is a key element of successful surgery and will be discussed with you prior to deciding on surgery. Several medical studies have shown that patients undergoing abdominal surgery performed by surgeons specialized in Colon and Rectal Surgery meet with improved outcomes.

Robotic Surgery

Robotic surgery is a new innovative approach to surgery that overcomes the limitations of traditional surgery and conventional minimally invasive or laparoscopic surgery. Robotic surgery is performed through small incisions that introduce miniaturized wristed instruments and a high-definition 3D camera. The surgeon is seated at the console where the state-of-the-art robotic computer system translates the surgeon’s hand movements into precise micro-movements of the instruments. The system cannot make any decisions on its own. The robotic system requires that every maneuver be performed with direct input from the surgeon.

Robotic surgery has its most profound effect with pelvic surgery including rectal cancer, rectal prolapse and enterocele repair. The surgeon can operate with better visualization, precision, dexterity and control than possible traditional surgical approaches, laparoscopic or open.

What are the benefits of robotic surgery?

The same benefits seen with laparoscopic surgery are also seen in robotic surgery including:

• • less postoperative pain and reduction in need for pain medication

• • quicker return to tolerating a diet

• • shortened hospital stay

• • earlier return to daily activities

• improved cosmetic results

In addition to these benefits, some of the benefits that are more specific to robotic surgery are:

• • Less injury to the nerves in the pelvis that control sexual function and bladder function

• • Excellent clinical outcomes for cancer control

• • More sphincter-sparing techniques especially in males and obese patients thus avoiding a permanent colostomy

• Less blood loss

Is robotic surgery safe?

Like laparoscopic surgery, robotic surgery is as safe as traditional open surgery and has been shown to be as effective as traditional open surgery when performed by an appropriately trained surgeon. Robotic surgery is essentially laparoscopic surgery with some additional technologic advancement, such as 3-D vision instead of a 2 dimensional flat screen which the operating surgeon uses to view the operative field. Robotic surgery has the same benefits of laparoscopy, again with some important improvements, such as less risk of injury to pelvic nerves that control sexual and bladder function and improved ability to preserve the anal sphincter muscles to avoid a permanent end colostomy.

Who is a candidate for robotic surgery?

The first step in deciding whether a robotic approach is feasible will be made during pre-operative consultation – this will be based on your specific condition, the extent of disease and your past medical/surgical history. The final determination is made at the onset of surgery, upon entering the abdomen the surgeon will evaluate the abdominal cavity and determine if it is safe to proceed in a laparoscopic and/or robotic fashion. It is not unusual for a hybrid approach to be used- some of the surgery done with traditional laparoscopy and often the pelvic dissection performed using the robotic approach. As with any intestinal surgery, certain risks related to anesthesia, bleeding, infection and bowel leaks (anastomotic breakdown) exist. These risks depend on your pre-operative health, the condition being treated and the specific operation being performed. An assessment and minimization of these risks is a key element of successful surgery and will be discussed with you prior to deciding on surgery. Several medical studies have shown that patients undergoing abdominal surgery performed by surgeons specialized in Colon and Rectal Surgery meet with improved outcomes.