Colon Surgery, Improved
The key trend in surgery in the past two decades has been the use of minimally invasive, laparoscopic procedures.
The key trend in surgery in the past two decades has been the use of minimally invasive, laparoscopic procedures. Instead of large incisions, surgeons cut small ports, or openings, through which they insert a camera, light source and instruments to do their work. The benefits are less pain, quicker recovery, less scarring, reduced risk of wound complications and earlier discharge from the hospital. In the past two years, minimally invasive colorectal surgery has become even more minimal. One Saint Peter’s University Hospital surgeon now performs certain colon operations through a single port, rather than the three to four generally used for laparoscopic procedures.
"This is a big technological advance in laparoscopic surgery," says Sanjiv Patankar, M.D., chief of Colorectal Surgery at Saint Peter’s, one of only a few hospitals in the country to offer the new procedure, called single-port laparoscopic colon resection. It allows him to surgically remove a segment of the colon through a single incision, less than 2 inches long, that is typically made in the belly button (meaning only a very small scar will be visible).
Single-port resection is made possible by a specially designed tool and surgical technique called the Single Incision Laparoscopic System. "This is a special access device that has a gel diaphragm,
through which we insert our instruments and laparoscope to see and record the site, which is magnified on a screen in the operating room," Dr. Patankar says.
Great skill is required. "The range of movement is restricted because all the instruments go through the single port, so correct positioning of the instruments is more difficult," he says. It helps if a surgeon has lots of experience with conventional laparoscopic surgery. Fortunately, Dr. Patankar has done several hundred such procedures. "I felt very comfortable learning these new skill sets for this highly complex procedure," he reports.
Because the single-port approach is still relatively new, there is no hard data yet on its benefits. But Dr. Patankar believes it will extend the already significant benefits of using laparoscopy, resulting in "even less pain, less risk of wound complications and quicker discharge from the hospital," he says. "Already my single-port patients have gone home in just two or three days, a day or two sooner than traditional laparoscopy patients."
The technology takes laparoscopic surgery one step further in achieving better patient outcomes, says Dr. Patankar, and about 40 percent of his surgical patients are candidates for single-port surgery. Because of the anatomic location of the colon, the best candidates are patients who need surgery on the right side to remove, or resect, colon tumors or polyps that cannot be removed during a colonoscopy. "If the tumor is larger than 4 centimeters, it won’t work," he says. "Also, patients with prior abdominal operations will have scar tissue, so they are not ideal candidates.
"When patients meet the requirements I always offer single-port surgery," Dr. Patankar says. "There’s no reason not to. There’s no downside to trying it. If for some reason it’s not working out, we can always insert additional ports or even move on to open surgery. The technology is here to stay. It’s a win/win for the patient."
