Minimally invasive surgery can be successfully performed for colon and rectal CA, but also for benign colon and rectal conditions including diverticulitis, colon polyps, inflammatory bowel diseases (Crohn's Disease and Ulcerative Colitis,) and rectal prolapse. It can be used to remove the entire colon and rectum or just a portion, or segment, of the colon. Minimally invasive techniques can be used to create an ostomy (surgically created opening between an internal organ and the body surface). They may be either a colostomy (connecting a part of the colon to the skin of the abdominal wall) or an ileostomy (connecting the last part of the small intestine, or ileum, to the skin of the abdominal wall). Also, minimally invasive techniques can be used to reconnect the intestine from a temporary ostomy. Complex reconstruction surgeries, such as ileal pouch creation can be performed in a minimally invasive fashion. There are very few traditional abdominal colon and rectal procedures that cannot be performed in a minimally invasive manner.
In order to perform operations inside the abdomen, surgeons must make an incision large enough to offer adequate visibility, provide access to the abdominal organs and allow the use of hand-held surgical instruments. These incisions may be placed in different parts of the abdominal wall. Depending on the size of the patient and the type of operation, the incision may be 6 to 12 inches in length. There is a significant amount of discomfort associated with these incisions that can prolong the time spent in the hospital after surgery and can limit how quickly a patient can resume normal daily activities.
Minimally invasive procedures use advanced technologies to avoid the need for the large incisions used in traditional open surgery. The development of these techniques has been an important advance for the benefit of patients and is useful for the treatment of many conditions. "Laparoscopic surgery" is a specific type of minimally invasive surgery, but the term is sometimes used to refer to minimally invasive surgery in general. "Robotic surgery" is also a minimally invasive surgery similar to laparoscopic surgery, but with the use of a more advanced robotic platform.
The goal of MIS is to decrease pain and speed recovery by eliminating the need for a large abdominal incision. All minimally invasive surgeries are performed with the patient asleep under a general anesthetic.
Laparoscopic surgery refers to a technique where the surgeon makes several small incisions about ½" in size, instead of a single large incision. For most colon and rectal operations, 3-5 incisions are needed. Small tubes, called "trocars," are placed through these incisions and into the abdomen. Carbon dioxide gas is used to inflate the abdomen in order to give the surgeon room to work. This allows the surgeon to use a camera attached to a thin metal telescope (called a laparoscope) to watch a magnified view of the inside of the abdomen on operating room monitors. Special instruments have been developed for the surgeon to pass through the trocars to take the place of the surgeon's hands and traditional surgical instruments. For most operations, a slightly larger incision (about 2-4 inches in length) must be made in order to remove tissue (sometimes called a "specimen") from the abdomen.
"Robotic surgery" or "robotic-assisted surgery" is a newer variation on minimally invasive colon and rectal surgery. The technique is very similar to standard laparoscopic surgery in that instruments are passed into the abdomen through trocars. Rather than manipulate the instruments manually, the surgeon sits at a console, or special computer desk, and manipulates small controllers while observing the inside of the abdomen with a 3-D monitor. A sophisticated computer system translates the movements of the surgeon's hands to the robot, which then moves the surgical instruments.
Because the incisions are much smaller than those used in traditional surgery, there is usually less discomfort following minimally invasive surgery. This has bene shown to result in a shorter hospital stay, less need for prescription pain medications, an earlier return to normal activities and less visible scarring.