Many colorectal surgery milestones have come from Cleveland Clinic. Our surgeons are responsible for the first continent ileostomy in 1977, giving these patients who have their entire colon and rectum removed an alternative to the external pouch. And in 1991, we performed the first laparoscopic colorectal surgery.
“Over the past decade, we have led the world in laparoscopic surgery. We have one of the highest volumes at any single center in the nation,” observes Feza H. Remzi, MD, Chairman of the Department of Colorectal Surgery for DDI. “The future is to push the envelope: smaller incisions, fewer ports, different extraction sites.”
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Colorectal surgeon Dr. Meagan Costedio discusses the benefits of removing the colon through single-port surgery
Colorectal surgeons in the Digestive Disease Institute (DDI) were the first in the world to perform a single-port proctocolectomy – removing the entire large intestine and rectum through the belly button using a single-incision. Our program is one of few in the nation offering this procedure, which improves quality of life for patients with colon cancer, Crohn’s disease, ulcerative colitis, diverticulitis and constipation. To-date, we have performed more than 150 procedures with excellent results and safety equivalent to traditional laparoscopy.
How Does It Work?
Single-port colorectal surgery is a form of minimally invasive (laparoscopic) surgery. In traditional laparoscopic surgery, a telescopic rod connected to a video camera (laparoscope) is inserted through a small incision in the abdomen. Three to five additional small incisions are made and used as “ports” in which to insert instruments to remove a colon, in this case. In comparison, the single-port procedure uses only one incision (about 4 mm long) in the belly button.
Benefits of single-port surgery:
Because it uses only one port, single-port surgery leaves little to no scarring and may reduce complications that commonly occur after traditional open and even traditional laparoscopic abdominal surgery. The results for patients are reduced pain, minimal or no scarring, shorter hospital stays and faster recovery compared to traditional laparoscopy.
Robotic surgery is one of the latest innovations in laparoscopic surgery. Meagan Costedio, MD explains how robotic surgery has revolutionized this procedure.
How does the robot help you see better while you are operating?
During open surgery, we usually stand one to two feet away from where we are operating. In the pelvis, we have to operate behind the pubic bone, so it is very difficult to see small nerves and blood vessels around a corner from that far away.
When I’m performing a regular laparoscopy, the camera is like only having one eye. This means that there is only two-dimensional vision – no depth perception. The more you practice, the better your learned depth perception gets.
However, it is much easier to see what I am doing with the robot because the robotic camera has the equivalent of two eyes. When I look in, I have normal depth perception as if my own eyes were able to get to where the camera can go. Now, we can drive the camera under the pubic bone and look at those nerves and blood vessels from inches away. The difference is night and day.
When do you like to use a robot?
The robot helps in tight spaces that require suturing so it is great for prostate and uterine surgeries. It helps in the pelvis, so it is good to use when treating rectal cancer and for repair of rectal prolapse.
Patients with pathology in one area are good candidates: those with prostate cancer, bladder cancer, rectal cancer, rectopexy, needing hysterectomy or ovaries removed.
What is the typical recovery time?
For a rectal resection, patients are generally in the hospital from four to seven days and recovering at home for about six weeks. Generally, there is less pain, less blood loss and shorter hospital stays than with open surgery.
Transanal Endoscopic Microsurgery (TEMS) is a procedure performed entirely through the anus and rectum and offers an effective, quick-recovery treatment to completely remove large rectal polyps and early-stage rectal cancer.
What should a patient know?
Because no incision is necessary, TEMS is an excellent alternative to major abdominal surgery with a much quicker recovery time. The procedure is virtually painless and requires only an overnight stay at the hospital. It’s an important option for the elderly or others who can’t tolerate major abdominal surgery.
Other important advantages to TEMS surgery:
- Less bleeding
- Reduced risk of infection and complications
- Less risk of bowel obstructions post-surgery
TEMS isn't as widely used as laparoscopic surgery or robotics in treating colorectal cancers because the procedure is difficult to perform. Also, the number of patients is limited because the instruments and scope are straight and the patient’s backbone can get in the way of the surgeon reaching polyps or cancers in the rectum.
Who can have TEMS?
During your colonoscopy, if large polyps or early stage rectal tumors are found in your rectum that can’t be removed by the colonoscope, you’ll be referred to a rectal surgeon.
If you’re an appropriate candidate, TEMS may be an option. Talk to your surgeon to find out for sure.
What happens during TEMS?
Before the TEMS procedure, you undergo a full bowel preparation – just like a colonoscopy.
What happens during the surgery:
- Patients receive a general anesthetic.
- Before the surgery a proctoscope — a tube fitted with the two long, skinny TEMS microsurgical instruments and a camera — is inserted into the anus and rectum. It is positioned over the lesion to be removed.
- The rectum is filled with gas so the surgeon has room to see and remove the rectal polyps and early stage cancer.
- Using the instruments the surgeon grabs the lesion, cuts it out, and sutures the area.