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