Minimally Invasive Colon Surgery Has Patient Benefits

Rita Lupine suffered four intense bouts of diverticulitis, an inflammation of the small pockets in the colon wall, that each lasted a few days. The sharp pains in her lower abdominal region, combined with fever and chills, kept her housebound and on medication. Between bouts she had to watch her diet and was restricted from eating corn, nuts and anything with seeds. The problem had become chronic.

“Each time it happened I was out for several days from work in intense pain,” she recalls. “And there was always the possibility of a perforated diverticulum, which happened to my sister. I definitely wanted to avoid that.”

After meeting with Debra Tarantino, M.D., attending colon and rectal surgeon with Saint Barnabas Medical Center, Ms. Lupine, a nurse in the Department of Radiology, decided to undergo a colon resection (removal of the diseased section). In April 2005, Dr. Tarantino performed the surgery and Ms. Lupine recovered for three days in the hospital. Within 10 days she felt strong enough to resume driving.

“I was really glad I had it done that way,” says Ms. Lupine. “Dr. Tarantino removed the problematic portion of my colon through a small abdominal incision approximately three inches in length. Now I have no diet restrictions and I am pain free.”

Laparoscopic Colon Resection Surgery

The colon, or large intestine, is located in the lower portion of the digestive track. Food is digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste moves through the colon to the rectum and and is expelled from the body.

According to the Society of American and Gastrointestinal Surgeons, more than 600,000 surgical procedures are performed in the U.S. each year to treat a number of colon diseases. These diseases include cancer, diverticular disease, blockage of the intestine, precancerous or especially large polyps, and ulcerative colitis that has not responded to treatment.

Surgery is often considered to be the best way to stop the spread of disease and alleviate pain and discomfort, reports Dr. Tarantino.

In traditional colon resection, the surgeon makes a long incision in the abdomen to reach the colon. Traditional surgery results in a hospital stay of five days, with six weeks of postoperative recovery. Laparoscopic colon resection allows for the same operation to be performed through much smaller incisions. This results in less postoperative pain, shorter hospitalization and a better cosmetic result. Patients leave the hospital in 48 to 72 hours and return to normal activities in about two weeks.

“The real benefits are found in the first two weeks,” Dr. Tarantino says. “Laparoscopic surgery patients leave the hospital more quickly and feel better sooner.”

Some recent studies have also found that that immune function is better preserved with laparoscopic colon surgery. A significant depression of immune function occurs after major open operations and lasts for at least three days. Researchers found this effect does not occur in laparoscopic patients. Maintaining immune function after surgery may lower infection rates and contribute to lower tumor recurrence rates.

The Procedure

In laparoscopic colon resections, surgeons operate through four or five small openings (each about a quarter inch) while watching an enlarged image of the patient's internal organs on a television monitor. Using a cannula (a narrow tube like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs. Several other cannulas are inserted to allow the surgeon to remove part of the colon.

Treating Colon Cancer Laparoscopically

Depending on the stage and spread, some colon cancers can be completely removed, says Dr. Tarantino. In the majority of such cases, surgery involves a resection (removal) of the primary cancer and regional lymph nodes, along with the removal of sections on both sides of the normal bowel. Conventional surgery involves an invasive procedure through a large opening in the abdomen to remove cancer in the colon. In laparoscopic surgery, a few one-centimeter incisions are made in the patient’s abdomen. The cancer is then removed by extending one of the incisions to accommodate the bowel.

The benefits of minimally invasive surgery for cancer are similar to those seen for benign disease, and are related to less surgical trauma. The small incisions are associated with less pain, and related benefits include quicker resumption of diet and shorter hospitalization. Some studies have noted fewer complications and overall quicker convalescence following the laparoscopic approach, says Dr. Tarantino.