Surgeons perform first single-incision proctocolectomy
Cleveland Clinic surgeons used a single-port approach to remove the entire large intestine of a 13-year-old patient who was diagnosed with a rare, genetic condition that leads to colon cancer. The successful, minimally invasive surgery left only a coin-sized scar on his abdomen.
The surgery, performed by Cleveland Clinic colorectal surgeon Daniel Geisler, MD, FACS, FASCRS, removed the boy’s entire large intestine and rectum, and created a j-shaped pouch from the small intestine to reconnect the digestive tract. The total proctocolectomy significantly reduces the patient’s risk of developing colon cancer.
The total proctocolectomy and ileoanal pouch procedure, performed on June 17, is believed to be the first in the world done through a single-incision, laparoscopic technique. The technique leads to significantly reduced external scarring, decreased infection risk, reduced post-operative pain and faster recovery for the patient.
“By operating early, we have greatly reduced the patient’s risk for developing a difficult to treat colon cancer,” says Dr. Geisler. “Patients have significantly less external scarring and recover much faster when we use this technique.”
The procedure was recommended for the boy after a colonoscopy examination by James Church, MD, discovered many polyps in his large intestine. The polyps were caused by an inherited condition called familial adenomatous polyposis, or FAP, which causes the growth of hundreds of pre-cancerous polyps in the colon and rectum.
“Polyps from FAP lead to cancer in nearly 100 percent of patients by age 40, with potential for cancer even before that age,” says Dr. Church, Director of the David G. Jagelman Inherited Colon Cancer Registries. “Our understanding of the genetic cause of the disease, along with surgical innovation, allows us to develop preventive treatment plans that significantly reduce the hospital stay for what used to be a major surgery.”
Cleveland Clinic’s innovation in minimally invasive surgery also includes the first single-port laparoscopic colon resection entirely through a single incision in the navel, performed in 2007 by Feza Remzi, MD, Chairman of Colorectal Surgery in the Digestive Disease Institute. “We are proud of Dan Geisler and our surgical team who marked another step forward in our effort to reduce the recovery period and cosmetic effects of surgery, while maintaining a record of successful long-term outcomes,” says Dr. Remzi.
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