|
1. Laparoscopic Colectomy
Until recently, colorectal surgery required an open (large incision)
technique. Now, a minimally invasive technique, laparoscopic colectomy,
can be used in the treatment of many colorectal diseases.
A laparoscope, telescopic videocamera, is used to allow surgeons to see
internal organs during an operation. A colectomy, removal of a part of the
large intestines (colon), is done for many disease processes including:
diverticulitis, Crohn’s disease, Ulcerative Colitis, and colorectal
cancer.
Traditional procedures required a large incision, 8 to 12 inches long.
Minimally invasive surgery uses three to five smaller incisions, in which
a laparoscope and surgical instruments can be inserted. With laparoscopic
surgery, patients may experience less pain and may have a faster recovery
from the hospital.
2. Procedure for Prolapse and Hemorrhoids (PPH)
Internal and external hemorrhoidal tissues are normal anatomically
structures. Prolapse of these hemorrhoidal tissues is a very common
condition. Hemorrhoids can become symptomatic from edema or thrombosis. In
some cases, surgical excision of hemorrhoids may cause relief for
patients.
Procedure for Prolapse and Hemorrhoids (PPH), also known as stapled
hemorrhoidectomy, is a new technique for hemorrhoids that was recently
developed. It is a surgical treatment of the hemorrhoidal complex by
reducing the anal mucous prolapse with a circular stapler.
Patients may experience less pain than with an excisional
hemorrhoidectomy and may have a quicker recovery from surgery.
3. Transanal Endoscopic Microsurgery (TEM)
Transanal Endoscopic Microsurgery is one of the minimally invasive
surgical techniques that has become available in the past decade. One of
the main benefits of TEM is that an abdominal operation (anterior
resection of the rectum) is avoided. Because a minimally invasive approach
is utilized, pain in minimal.
The operating proctoscope, with a diameter of 4 cm, can reach up to 20
cm, allowing operation of the long instruments in a small operating field.
The long instruments, including an electric knife, scissors, needle
holder, forceps and clip applier, are used to cut, dissect and sew. In
place of knots, silver clips are applied to sutures. In addition, a
special machine will insufflate carbon dioxide, opening the rectum.
TEM is useful for small carcinomas (less than 2 cm in size) and any
benign adenoma that cannot be snared. For a patient consideration, his or
her proximal margin must be in a direct straight line as measured by the
rigid sigmoidoscope. This upper margin limit is usually around the 15 cm
level.
Additional sites that must be avoided for a full thickness excision
with a carcinoma is the cul de sac of the peritoneum and the vagina. For
carcinomas, the clinical examination is complemented by endolumenal rectal
ultrasound, which verifies that the invasion is not full thickness. If the
carcinoma is determined to be full thickness. If the carcinoma is
determined to be full thickness by preoperative clinical examination,
preoperative ultrasound or postoperative pathological examination,
transabdominal anterior resection should be carefully considered.
There are several risks associated with TEM. If the TEM operating scope
cannot be advanced to reach the proximal margin of the tumor, the
alternative treatment-most often abdominal surgery-is indicated. If the
vagina or peritoneal cavity is entered, it must be repaired transrectally
or transabdominally. Even colostomy may be warranted.
In addition, the stretch of the sphincter to accommodate the 4 cm scope
has resulted in a few reports of weakening of the sphincter, but not frank
incontinence.
West Penn’s surgeons have pioneered this technique in the United States
and have published their results in the medical literature. (Transanal
endoscopic microsurgery. Initial registry results. Diseases of the Colon
and Rectum 1996 Oct; 39: pp.579-584. Authors: Smith LE, Ko ST, Saclarides
T, Caushaj P, Orkin BA, Khanduja KS.) |