Laparoscopic or minimally invasive surgery began to develop in routine practice in the early 90’s of the last century and is currently widespread in multiple processes, the most common being the removal of the gallbladder. The procedure requires small incisions (0.5 to 1cm) through which instruments and optics connected to a video camera and a high-resolution monitor are introduced into the abdomen. Through these instruments, experts in surgery and coloproctology observe the inside of the abdomen and carry out the same interventions but in a less aggressive way.
Peculiarities of laparoscopy of the colon and rectum
Laparoscopy of the colon and rectum is a complex surgery, since it presents the difficulties of having to work on a long and mobile organ and, in addition, having to remove a large area. This is done through a small and sometimes relatively hidden incision (over the pubis, for example), or even, although less frequently, through natural orifices, such as the vagina or the anus itself. The surgical technique is similar to that performed in classic open surgery, although using specific and longer instruments, as well as special maneuvers, always with the philosophy of achieving the maximum benefit with the least aggression.
Operations and pathologies that can be approached laparoscopically
Practically all colon and rectum surgery can be performed laparoscopically, although it is not indicated in all specific cases, and there are contraindications (patients with multiple abdominal scars, very advanced tumors, severe cardiovascular pathology, etc.), which mean that the feasibility of the procedure must be assessed in each patient. In addition, in the event of difficulties or problems once the operation has begun, the abdomen can always be opened conventionally. Laparoscopic resections of the right and left colon (hemicolectomies), complete removal of the colon or total colectomy, rectal resections and even resections of the entire colon and rectum (proctocolectomies) can be performed.
The pathologies in which laparoscopy can be performed are, in order of frequency, malignant and benign tumors, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), and diverticular disease. More recent modalities with well-defined indications are transanal endoscopic surgery (TEO, TEM, TAMIS), and transanal excision of the mesorectum (TaTME). Stomas such as colostomies or ileostomies, rectal prolapse repairs and other interventions that do not require the removal of any organ can also be performed. Although the use of these techniques varies according to the surgeons’ experience, an average of 50% of cases of colon and rectal surgery in our country are approached laparoscopically and, in many centers, in a clearly higher percentage.
Does laparoscopy offer the same safety as conventional surgery?
Given that when laparoscopic surgery is performed, the correct thing to do is to perform the same operation as when it is performed by the conventional route or laparotomy, the safety of the surgery is identical if there is an experienced surgeon. It has already been mentioned that patient selection is fundamental to obtain good results. As in any type of intervention, it can be associated with specific risks that will be detailed by your surgeon.
Pre and postoperative care specific to laparoscopy
In general, no specific preoperative or postoperative care is required. However, as postoperative discomfort is much less, it depends mainly on the size of the abdominal incision, since the evolution is more comfortable and the patient can recover quickly in the absence of complications. It should not be forgotten that surgery itself involves an aggression or trauma and, if this is minor, it will result in less blood loss, less postoperative pain and need for painkillers, minimal or invisible scars and a quicker recovery.