What is the role of laparoscopic surgery for the treatment of diseases of the colon?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Most gastrointestinal (GI) surgeons now accept that laparoscopic surgery for both benign and malignant diseases of the colon is within the mainstream of patient care and that it results in superior clinical outcomes (eg, shorter hospital stay, less surgical-site discomfort, and quicker return to normal activity) as compared with open surgery (OS). [1, 2, 3] Laparoscopy has been associated with a lower incidence of both surgical-site infections (SSIs) [4, 5] and hernias [6] and with greater patient satisfaction as compared with laparotomy. [7, 8]

Although concerns regarding recurrence and survival rates associated with laparoscopic colon cancer resections initially dampened enthusiasm for minimally invasive surgery (MIS) in this setting, subsequent clinical studies established that properly performed laparoscopies produce comparable colon cancer outcomes comparable to those of OS, as well as improved clinical results. [9, 10]

The prolonged operating time was one of the concerns with minimally invasive left colectomy. In a study aimed at addressing this concern, Sweigert et al examined overall morbidity, SSI rate, and length of hospital stay in patients undergoing laparoscopic left colectomy compared with those undergoing open left colectomy. [11] Despite the longer operating time, laparoscopic left colectomy was associated with lower risk-adjusted rates of overall morbidity and SSI and shorter hospital stays. The laparoscopic left colectomy group also had lower rates of composite 30-day death or serious morbidity.

A “division of labor” has occurred within the field of MIS techniques, which has shaped a number of innovations that include robotic assistance, [12, 13, 14, 15] more reliable energy devices, endostaplers, and a motivation to reduce the number of access sites (even to the point of limiting surgical access to a single port).

In the United States, despite the advantages afforded to patients by laparoscopy, the adoption of these techniques in the general population is still limited to a minority, though the proportion has been growing. [16] Much of the reluctance to implement laparoscopic techniques has been related to the technical challenge posed by complex laparoscopic procedures such as colon resections. The following article describes the fundamental aspects involved in approaching a laparoscopic left hemicolectomy (left colectomy).

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