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In just the past ten years, the field of minimal access,
minimally-invasive, or laparoscopic (lap-rah-sca'-pick) surgery
has skyrocketed. Today, laparoscopic surgery is the standard
of care, or operation of choice, for procedures such as cholecystectomy
(gallbladder removal) or Nissen fundoplication (wrapping the
stomach around the esophagus to correct GERD, or gastroesophageal
reflux disease). Generally, the benefits of all the new laparoscopic
procedures include less postoperative pain and therefore,
less pain medication, faster healing for a quicker return
home, and smaller, less noticeable scars after healing.
In 1991, surgeons first began performing laparoscopic-assisted
colon resections to treat colorectal cancer and other disorders.
Unlike the procedures noted above, colonic resections are
technically more difficult, usually requiring dissection in
more than one area in the abdomen, in addition to separating
the bowel from the blood vessels that supply it in order to
remove a portion of the intestine.
In the surgery, the abdomen is inflated with carbon dioxide
gas to lift the abdominal wall away from the internal organs.
Hollow cylinders called ports are inserted through 1/2"
to 1" insertions in the abdominal wall to provide access
for the surgical instruments. These ports have valves that
permit insertion of instruments but prevent the carbon dioxide
from escaping.
The laparoscope, a fiber-optic telescope, is inserted through
one port and attached to a camera. It sends images from the
abdominal cavity to television monitors placed for easy viewing
by all the operating room personnel. Thus, the surgeon and
his or her assistants can view the abdominal cavity and its
contents. Through the remaining ports, long-handled instruments
are used to perform fine dissection, cutting, and suturing,
eventually joining two ends of bowel together, called an anastomosis.
Risks of laparoscopic-assisted colon resection
During the first two years after the introduction of laparoscopic-assisted
colon resection, there were reports of increased cancer recurrence
at the sites where the ports had been placed. It is now believed
that this initially higher rate of recurrence may be attributed
to poor surgical technique during the early days of the procedure.
Nonetheless, this recognized development of port-site tumors
prompted the launch of a multi-hospital clinical trial to
compare outcomes of laparoscopic verses traditional open colon
resection operations for patients with cancer. Under the auspices
of the National Cancer Institute, Columbia Presbyterian is
one of 40 hospitals in the United States approved for participation
in the study. Additional scientific research studies are underway
at Columbia Presbyterian to investigate what effects, pro
or con, the use of laparoscopic surgical techniques may have
on the immune function. Early data indicate that an organism's
immune response may benefit from minimally-invasive procedures,
verses the traditional. If confirmed, this finding would offer
further proof that laparoscopic surgery provides meaningful
benefit in the treatment of both benign and malignant diseases.
In summary, a minimally-invasive surgical approach to the
treatment of colorectal disease may reduce postoperative pain
and medication levels, promote faster return of bowel function,
and improved cosmetic results. It is important to remember,
however, that not all patients are candidates for laparoscopic
surgery. Your surgeon will be able to provide you with the
most appropriate treatment options for your individual situation.
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