FREQUENTLY ASKED QUESTIONS CONCERNING LAPAROSCOPY

HOW IS LAPAROSCOPIC COLON RESECTION PERFORMED?

"Laparoscopic" and "open" colon surgery simply describe the techniques a surgeon uses to gain access to the internal surgery site.

Most laparoscopic colon procedures start the same way. Using a canula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the canula, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Several other canulas are inserted to allow the surgeon to work inside and remove part of the colon. The entire procedure may be completed through the canulas or by lengthening one of the small canula incisions.

WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC COLON RESECTION?

Results may vary depending upon the type of procedure and patient's overall condition. Common advantages are:

• Less postoperative pain
• Shorter hospital stay
• Results in a faster return to solid-food diet
• Quicker return of bowel function
• Quicker return to normal activity
• Better cosmetic results
• Less complications

WHO IS A CANDIDATE FOR LAPAROSCOPIC SURGERY?

Patients who have the following conditions: 

• Colon Cancer
• Rectal Cancers
• Colonic Inertia (Chronic Constipation)
• Diverticulosis
• Diverticulitis
• Ruptured diverticulitis (emergency)
• Closure of colostomy
• Polyps
• Rectal Prolapse
• Colo-vagina Fistula
• Colon-bladder Fistula
• Ulcerative Colitis
• Colonic Volvulus
• Small Bowel Obstruction
• Incisional Hernia
• Appendicitis

WHEN CAN LAPAROSCOPIC SURGERY NOT BE PERFORMED OR COMPLETED?

Patients who have the following conditions:

• Severe abdominal adhesions from previous surgery
• Unclear anatomy
• Extensive cancer
• Complications occurring during surgery

IF LAPAROSCOPIC SURGERY CANNOT BE PERFORMED, WHAT IS THE NEXT STEP?

    Hand-assisted laparoscopic surgery is an alternative before converting to open surgery.

WHAT IS HAND-ASSISTED LAPAROSCOPIC SURGERY?

    In hand-assisted surgery, the surgeon can insert a hand through the small incision via a special pressurized sleeve. In this procedure, the surgeon makes a small incision in the abdomen and inserts his hand into the patient’s body, using it for sensory perception and to guide the surgical instruments he manipulates with his other hand while observing the entire procedure on a TV screen overhead. With both a hand and laparoscopic instruments doing the work, the surgeon has more control over the operation and sense of depth and sensation of touch than can not be gained through the lens of a camera. The large organ can be removed intact, making it possible to evaluate the cancer. The hand-assisted approach is also considered better for surgeons who are still learning laparoscopic techniques.Hand-assisted laparoscopic surgery is the use of the non-dominant hand intra-abdominally, together with the laparoscopic instruments in the right hand.

WHAT COMPLICATIONS CAN OCCUR?

The same as for open surgery:

• Bleeding
• Infection
• Bowel obstruction

HOW MANY LAPAROSCOPIC COLON CASES HAVE YOU PERFORMED?

    I have performed approximately 1500 cases since 1992.

WHAT IS YOUR CONVERSION RATE TO OPEN SURGERY DURING LAPAROSCOPIC SURGERY?

    It is 3%.

WHAT IS THE SHORTEST HOSPITAL STAY THAT YOU'VE HAD AMONGST PATIENTS?

    Five patients have left the following day after surgery. Four dozen people have left after two days. Most people stay in the hospital for 3-5 days.

WHAT SHOULD I DO TO PREPARE BEFORE SURGERY?

• Stop taking blood thinner five days before surgery
• Bowel prep - clear liquid diet the day before surgery; Dulcolax (three tablets at 2:00 p.m.); drink bowel cleansing liquid at 6:00 p.m.
• Nothing by mouth after midnight
• Report to hospital 2 hours before surgery
• Entereg 12mg at prep area to prevent paralysis of bowel
• Antibiotic (Invanz) 1.0 g at prep area
  

WHAT CAN I EXPECT IN THE RECOVERY ROOM?

• You will have a urine catheter (Foley) 
• You may have one or two drain tubes (Jackson-Pratt)
• You may have PCA (patient-controlled anesthesia) machine
• If all vital signs are stable you will be transported to the regular floor
• If you need to be monitored closely you may be transported to ICU (intensive-care unit)
  

WHAT CAN I EXPECT AFTER SURGERY?

After the operation, it is important to follow your doctor's instructions. Although many people feel better in just a few days, remember that your body needs time to heal.

• You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
• You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, work and sexual intercourse.
• If you have prolonged soreness, or drainage from any of your incisions, and are getting no relief from the prescribed pain medication, you should notify your surgeon.
• You should call and schedule a follow-up appointment within 2 weeks after your operation.