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Cartersville Surgical Associates, PC
970 Joe Frank Harris Parkway
Cartersville, GA 30120
Phone: 770.386.1261
Fax: 770.386.3873
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With advances in technology and skill, minimally invasive colon resection has become a reality. The traditional open approach to colon resection was performed through a large midline or transverse incision, required a 5-7 day hospitalization and resulted in a month long recovery time. Minimally invasive colon resection is done either hand assisted or totally laparoscopically.
In a hand assisted resection, a single incision approximately 5-7 centimeters in length is used to insert one of the surgeons hands to assist with mobilization. Additional smaller incisions are made to place trocars for laparoscopic visualization and dissection. The colon is then brought out the 5-7 cm incision, resected, and the anastomosis is then performed outside the abdominal cavity (extracorporeal anastomosis). The colon is then returned to the abdominal cavity and the incision is closed. This technique results in a smaller incision than the traditional open approach, may result in less pain, and may result in a shorter hospital stay. In the largest series to date of laparoscopic assisted resection, the average length of stay in the hand assist group was 5 days.
In a totally laparoscopic resection, the colon is mobilized through laparoscopic techniques without the surgeon introducing a hand. Laparoscopic staplers are then used to transect the colon and the colon is removed through an incision approximately 3-5 centimeters in size. The anastomosis is performed within the abdominal cavity utilizing a laparoscopic suturing or stapling technique (intracorporeal anastomosis). Utilizing a totally laparoscopic technique our average length of hospital stay is 2 days. Patients are allowed to drink liquids immediately after surgery and are started on a soft diet the day after surgery. Narcotic pain requirements are less in the totally laparoscopic group.
Until recently, there has been a fair amount of controversy in the medical literature about minimally invasive colon surgery when utilized for colon cancer. The debate has centered on the oncologic results of minimally invasive surgery, with some concern that the oncologic results in the minimally invasive group were not as good as in the traditional open approach. A recent study by Dr Heidi Nelson and her colleagues at Mayo Clinic in Rochester, Minnesota "A Comparison of Laparoscopic Assisted and Open Coletomy for Colon Cancer", indicates that the oncologic results are the same for both groups. This study was published in the New England Journal of Medicine in May of 2004.
This study was conducted by 66 credentialed surgeons at 48 institutions throughout the United States. Each surgeon had performed at least 20 laparoscopically assisted colo-rectal operations. Surgeons submitted videotapes of their surgeries to the principal investigators so that their technique could be reviewed with attention to oncologic technique. The end point of the study was patient survival. There were 872 patients enrolled in the study, 428 in the open colectomy group and 435 in the laparoscopic assisted group. The duration of surgery was longer in the laparoscopic assisted group, 150 minutes vs 90 minutes. The extent of resection was similar in both groups. The median number of lymph nodes examined was equal in both groups (12).
Perioperative recovery was faster in the lap assisted group than the open group. The hospital stay was shorter (5d vs 6d). There was a shorter duration of intravenous narcotic administration (3d vs 4d). The complications, long and short term were the same in both groups.
The median follow-up was 4.4 years. In this time period, 160 patients developed recurrent disease. Of those with recurrent disease, 84 were in the open groups and 76 were in the laparoscopic assisted group. There was no statistical difference in the two groups. When looking at overall survival, the results in both groups were likewise equivalent. Disease free survival was also the same in both groups, and the findings of overall and disease free survival being equivalent held true for any stage of cancer.
This study is the largest series to date and has ushered in a new era for oncologic colon surgery. It is important to note that this surgery was laparoscopic assisted and that the difference in length of stay will be more pronounced when using a totally laparoscopic approach. We can now offer the advantages of minimally invasive surgery to our patients with colon cancer with the knowledge that the oncologic outcome is the same as the traditional open technique.
In addition to colon cancer, diverticular disease can be treated utilizing a minimally invasive technique. In the unsual event that a benign colon polyp cannot be removed colonoscopically, laparoscopic surgery is an excellent alternative. Depending on the location and size of the polyp, either a segmental resection of the colon or laparoscopic polypectomy can be performed.
Cartersville Surgical Associates has an extensive experience with laparoscopic colorectal surgery as well as other minimally invasive gastrointestinal surgeries.
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