From Stillwater-Ponca City (OK) Ostomy Outlook March 1998:

Laparoscopic Colon Surgery

summary by Bob Baumel of video shown at Feb 1998 meeting of Stillwater-Ponca City (OK) UOA Chapter. Video was a tape of a program broadcast on The Learning Channel

Our February 16 meeting featured a very interesting video of laparoscopic intestinal surgery, which Alice Bowman had recorded from TV's "The Learning Channel." Attendees were fascinated by the depicted operation, consisting of an ileocecal resection with intracorporeal anastomosis, performed on a 40-year-old man with Crohn's disease [Translation: a diseased section of bowel consisting of about 15 cm of terminal ileum and a small amount of proximal colon (cecum) was removed; then the cut ends of healthy bowel were brought together (anastomosed), with everything done inside the body, operating remotely with laparoscopic instruments].

In laparoscopic surgery, only very small incisions are made on the skin. In this case, five such openings were made, each of which was only 5 mm to 10 mm in diameter. The first opening was used for inserting a tiny video camera so the surgeons could see what they were doing. The other openings were for inserting various additional instruments.

One of the most important instruments is the surgical stapler, which simultaneously cuts tissues and closes the cut edges with rows of tiny titanium staples. These stapling devices have become essential in many types of surgery, but are especially important in laparoscopic surgery where virtually all joining of tissues inside the body is done with the stapler, since it wouldn't be practical to do it with conventional sutures (Sutures are used only at the very end, for closing the incisions on the skin). In this operation, the stapler was used for separating the diseased bowel from healthy bowel, for disconnecting the mesentery that supplied blood to the diseased bowel, for anastomosing the cut ends of healthy bowel, and for removing a diverticulum that was unexpectedly discovered during the operation.

It was interesting to see the differences between the diseased and healthy intestine: The diseased bowel was thickened and yellowish in color, while healthy bowel is soft and pliable, and pink in color.

The surgeon performing the operation explained that although early laparoscopic surgeries were done using modified versions of conventional surgical instruments, all instruments used now in laparoscopic surgery have been designed specifically for this purpose. He also said that for today's surgeons, it is helpful to have played video games, to develop "hand-screen" coordination!

Considering the tiny incisions used for laparoscopic surgery, you may wonder how the removed section of bowel (a pretty hefty chunk of intestine) was taken out of the body. The answer is that, as a final step of the procedure, one of the incisions was widened a bit, and this resected chunk of bowel (encased in a plastic bag to avoid contacting the skin wound) was pulled out. This couldn't be done any earlier because the incisions needed to be kept small and tight to keep the intestinal cavity inflated with gas during the laparoscopic steps.

A major benefit of the tiny incisions in laparoscopic surgery is much shorter recovery time. In this case, the patient could leave the hospital in 2 to 3 days, and resume normal activities after about a week. (Note: for ostomy surgeries, the shortened hospital stay may be a drawback, by reducing available time for instructing the patient in ostomy care while in the hospital.)

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Content last revised 1998-03-14