Laparoscopic colorectal surgery, also known as a keyhole or minimally invasive colorectal surgery, is an advanced and specialized technique that results in less post-operative pain, faster recovery, and reduced scarring in eligible patients.
Today, the laparoscopic approach can be used to treat both benign (non-cancerous) and cancerous colorectal conditions.
It is used and proven for cases of colon and rectal cancers, including selectively in those with locally advanced tumours or stage IV cancers. It has also been utilised in many benign conditions including diverticulitis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), polyps, or concurrent gynaecological conditions such as endometriosis involving the intestines.
Laparoscopic surgery for colorectal diseases has been proven to be the gold standard in many countries. For cancer conditions, laparoscopic surgery has strong scientific evidence that there are equivalent, if not superior long term survival outcomes.
Some of these procedures include:
- Colectomy (Right hemicolectomy/Left hemicolectomy/Subtotal colectomy/Total colectomy/Panproctocolectomy): To remove the colon partially or completely in order to treat conditions like colorectal cancer and inflammatory bowel disease, or genetic conditions such as Familial Adenomatous Polyposis. )
- Anterior Resection (High/Low/Ultra-low): To remove part of the rectum; commonly for rectal cancer treatment.
- Abdominoperineal Resection: To remove the rectum and anus; commonly used to treat advanced rectal cancers involving the anal canal. This surgery will require a permanent stoma thereafter.
- Rectopexy: To correct a rectal prolapse through repositioning and securing the rectum, so that it does not protrude.
How is it Done?
- The surgeon will make a few small incisions on the patient’s abdomen
- Hollow tubes, known as trocars, will be inserted into these incisions to create access points for the surgical tools and laparoscope (a flexible, long and thin tube that is fitted with a video camera and light)
- Carbon dioxide gas will be pumped into the abdomen in order to expand the abdominal space, allowing for better visualization and access
- Specialised surgical tools will be inserted through the trocars to perform the procedure; whether it be a tumour removal, tissue resection, and so on.
- The surgeon will continuously monitor the procedure on a monitor, thanks to the laparoscope’s camera projecting real-time images to guide the surgeon’s movements
- Once the procedure is complete, the surgeon will close the incisions; and the patient will be monitored in the recovery area until they are deemed fit for discharge
Who is Eligible for the Laparoscopic Approach?
While many colorectal surgeries can be performed laparoscopically today, they may not be suitable for everyone. In some complex cases or emergencies, the open technique may be required.
Nonetheless, most conditions are eligible for laparoscopic surgery. This will be based on an assessment of the disease condition, suitability of the patient for laparoscopic surgery and other factors. There are however some factors that may not allow one to be eligible for the laparoscopic approach:
- History of Extensive/Multiple Abdominal Surgeries: This means that there will be extensive scar tissue in the patient’s abdomen, which can prohibit placement of laparoscopic instruments.
- Emergencies: In certain acute colorectal conditions such as intestine perforation or severe intestinal obstruction, laparoscopic surgery is not suitable and will not be attempted)
- Pre-habilitation
- Our team will brief you on a diet and exercise plan prior to the surgery to build up your nutrition and muscle mass which will aid you in recovery.
- Bowel Preparation
- A specific preparation depending on the type of surgery you are going for will be ordered.
- Oral Antibiotics
- These oral antibiotics are prescribed the night before surgery and help to reduce post-op infections.
- Admission and Administrative Processes
- Pre-authorisation Letter of Guarantee (LOG) for insurance purposes will be done for you and this may take usually 5-7 working days
- Pre-operative blood tests and other investigations will be ordered to ensure you are optimised for surgery
- If you are on blood thinners, advice on when to stop will be given
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