Approaches to Colorectal Surgery

Colorectal surgery can be performed in many ways. This article explains the most commonly-used approaches.

Key Info

  • Laparoscopic surgery is the most frequently used type of colorectal surgery, and it is minimally invasive
  • Some procedures are now done with a surgeon-controlled robot that can make extremely precise moves
  • When necessary, a traditional (or open) surgery may be used to provide better access to the area in need of treatment 

Minimally Invasive & Laparoscopic Colorectal Surgery

Laparoscopic surgery is the standard of care for the majority of colorectal procedures. 

During laparoscopic 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. Through the remaining ports, long-handled instruments are used to perform fine dissection, cutting, and suturing.

The benefits of laparoscopy include:

  • less postoperative pain
  • lower pain medication requirement 
  • faster healing
  • quicker return home
  • smaller, less noticeable scars

During laparoscopic surgery, surgical instruments and a tiny camera are inserted through small ports in the abdomen.

TEMS: Transanal Endoscopic Micro Surgery

Transanal Endoscopic Micro Surgery is a minimally invasive surgical technique that has become the procedure of choice for certain colorectal conditions like the removal of rectal polyps and tumors on an outpatient basis. An advanced technique that requires special instrumentation and training, TEMS eliminates the need for radical surgery and a trans-abdominal approach. Compared to open surgery, TEMS provides benefits including fewer complications, better postoperative function, faster recovery, and reduced likelihood of needing an ostomy (temporary or permanent).

Robotic Surgery

While only offered at select centers (including Columbia), robotic surgery has become an option for the management of benign and malignant diseases of the colon and rectum. 

With robotic surgery, the procedure is still being done by a trained surgeon, but rather than that surgeon working directly with his or her hands on the patient’s body, they instead control a machine which can be precisely maneuvered to perform minimally invasive surgery.

Robotic surgery can be especially useful to operate in difficult to reach areas, such as within the confines of the pelvis.

Traditional (Open) Surgery

Before the creation of laparoscopic and robotic techniques, colorectal surgery was traditionally performed as an “open” procedure—referring to the fairly large opening a surgeon would have to make in the abdomen in order to get to the organs inside. Open surgery can be used to treat many types of colorectal conditions and in some cases may be necessary and life saving, but it is usually avoided if a minimally invasive option can be performed instead. 

Because of the large incision involved, open surgeries have a longer recovery and leave a more noticeable scar when compared to other approaches.

Next Steps

If you or someone you love is in need of care for a colorectal issue, we’re here to help. Our team is available for consultations, second opinions, and to perform any colorectal procedure, should one be necessary. Call us at (212) 342-1155 or request an appointment online.

Our surgeons have earned national and international recognition for their expertise in minimally invasive and laparoscopic surgery, and they routinely train other surgeons across the country. Our overall surgical outcomes compare highly favorably to national averages. Our surgeons are also experts in robotic colorectal surgery, a technology which is currently unavailable in most centers.  All of our surgeons are trained in the use robotic technology for the surgical treatment of colon and rectal cancer as well as other non-cancerous conditions.

Our surgical team is specialized in complex procedures which often allow preservation of the sphincter and minimize the need for a permanent ostomy even in difficult situations. Our experience with complex and reoperative abdominal and pelvic surgery also facilitates the surgical management of recurrent and locally advanced cancer as well as salvage operations in challenging situations. No matter the type of severity of colorectal condition you are dealing with, we can help.