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Laparoscopic Surgery for Intestinal Disease

Posted Aug 24 2008 1:49pm
ANNOUNCER: Surgery with a camera? Might sound like science fiction, but it's becoming business as usual in some operating rooms.

CONOR DELANEY, MD, PhD: Tradition has been that the surgery is performed in an open manner, and what that means is the patient has a reasonably large incision, and that can vary between being four and ten inches long.

Laparoscopic surgery is when we use little plastic or metal access ports or little cylinders that are placed through the abdominal wall through incisions generally one centimeter or less in size. We're performing this surgery using a little camera positioned through one of these ports into the abdomen, a little bit like playing on a Playstation. The Playstation console's generally in front of you. You're standing or sitting with the control in your hand and the screen is in front of you. So you're able to see over what you're doing and coordinate it with the image you're seeing on the screen.

ANNOUNCER: Having a new choice is good news for those people with intestinal disease that requires surgery.

CONOR DELANEY, MD, PhD: The common conditions that end up requiring surgery within the abdomen, particularly relating to the large and small bowel, are conditions like colon and rectal cancer, diverticulitis, and also inflammatory bowel disease, conditions like Crohn's disease and ulcerative colitis.

Apart from the incision that we use, the operations we perform are identical on the inside. So we're removing exactly the same piece of bowel that we would if we were doing it through an open technique, and we're joining the bowel back up together again in exactly the same way.

ANNOUNCER: People with certain types of colorectal cancer, ulcerative colitis and malformations of the gut, may not be right for laparoscopy, but for a number of people, this novel process can change the surgical experience.

CONOR DELANEY, MD, PhD: Laparoscopy allows us to use much less pain medication, and they don't get as constipated after surgery. They can get up and move more quickly, so they don't get a clot in their leg. And one of the other problems that are seen less after laparoscopic surgery is what we call post-operative ileus. And ileus is a condition one gets after surgery where the bowel shuts down for a very long period of time.

With an open surgical technique, we could expect that your bowel would take three to five days to start working again. If we do it laparoscopically, your bowel tends to take one or two days to start working again.

ANNOUNCER: With laparoscopic surgery, most patients can expect to spend less time in a hospital gown.

CONOR DELANEY, MD, PhD: We find that patients are able to tolerate diet, walk around, need less pain medications, and therefore get home earlier after surgery. So the postoperative stay in hospital is generally about half that seen in open surgery. People like getting home.

ANNOUNCER: A shorter hospital stay can even be better for your health.

CONOR DELANEY, MD, PhD: Patients who tend to stay in hospital for longer times are more exposed to risks of getting infections, and there are a variety of what we call nosocomial infections which are infections that one can acquire while in hospital. So we like to get patients home as early as possible.

ANNOUNCER: Looking down the road, patients having intestinal surgery also may find rewards with the newer technique.

CONOR DELANEY, MD, PhD: There are also some longer-term complications that are reduced by laparoscopic surgery, things like hernias and now we believe small bowel obstruction as well.

ANNOUNCER: Naturally some patients wonder if there are limitations when doctors view their surgery through a lens.

CONOR DELANEY, MD, PhD: Those of us who do laparoscopic surgery realize that the view is just as good, and perhaps even better because we're getting large magnification of the areas that we're operating on.

ANNOUNCER: Still patients should remember that performing laparoscopic surgery is cutting-edge, which means not every surgeon is up to speed.

CONOR DELANEY, MD, PhD: I think it's very important for patients who need any kind of bowel surgery to do research and to make sure that the institution they're going to and the surgeons they're going to see are experienced dealing with the condition they have. The Internet is a wonderful tool for doing this now.

ANNOUNCER: For those with intestinal disease, logging in some research hours is time well spent.

CONOR DELANEY, MD, PhD: The more surgeons who are trained to do it, and the more widely it becomes available, we're going to realize the true benefits that can be found with this technique. So more and more patients are going to find the benefits of quicker recovery, shorter hospital stay and quicker back-to-work.

ANNOUNCER: So surgery with a camera isn't science fiction. As a matter of fact, today there are some surgeries that are performed with robotics. Laparoscopy is yet another in a series of surgical advances that now provide even more choices to patients.

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