Laparoscopy in Colorectal Surgery

Laparoscopic surgery or “keyhole surgery” has been in routine use in gallbladder and gynaecological surgery for many years. It allows surgeons the opportunity to perform operations using very small incisions, avoiding the trauma of large incisions and the benefits of less pain, decreased hospital stay, quicker return to activity and work and an improved cosmetic result.

More recently laparoscopic surgery has been applied to colorectal surgery, a most exciting development. It has gained acceptance worldwide, however in Australia it is still only performed in a few specialized centres. Considerations for its use are applicable in benign conditions such as diverticular disease, rectal prolapse, polyps not suitable for colonoscopic removal, Crohns disease and endometriosis. It also has an emerging role in colorectal cancer. Like all surgery it carries its own complications but these are significantly reduced when carried out in experienced colorectal units.

The use of laparoscopic surgery for benign conditions has been well documented in the literature and has been shown to be a safe procedure when compared with conventional surgery. Patients who undergo surgery for diverticular disease and Crohns disease are generally in a younger age category and a faster return to work may be more important to them as may be a better cosmetic result.

Conversely, patients requiring rectal prolapse surgery are usually older and hence may not tolerate so well the more major abdominal procedure that is the traditional method of treatment for this condition. The ability to perform the surgery by laparoscopic techniques may thus minimise potential complications.

Laparoscopic surgery has an important role in exploration of the abdominal cavity in situations of unexplained symptoms, not elucidated on conventional testing such as radiology and requiring direct assessment, eg abdominal pain. This can be carried out in a day setting, thus reducing hospital length of stay.

The role of laparoscopic surgery in surgery for colorectal cancer is still under intensive investigation and a multicentre trial is underway in Australasia comparing laparoscopic surgery with conventional surgery assessing outcomes. The accredited laparoscopic surgeons of Sydney Colorectal Associates are actively participating in this important trial.

Another difficult area of management is endometriosis which affects many young women. A significant number may experience involvement of the wall of the bowel. In close cooperation with laparoscopic gynaecologists, we are providing expertise in colorectal laparoscopic techniques. Our surgeons provide services to two endometriosis centres, including the newly developed Sydney Endometriosis Centre at the Royal Hospital for Women.

Technological advances and innovation regarding opportunities for expanding the benefits of this form of surgery are developing rapidly. The boundaries of what may be possible in this field are quickly being redefined. Like all things new and exciting continuing research, both instrumental and clinical, needs to be addressed in this evolving field of surgery.