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Case Review

Single-Incision Laparoscopic Bowel Resection Helps Get Patient Back to Normal Activities Quickly After Polyp Removal

 

 

In December 2009, an experienced, respected community gastroenterologist contacted Aria’s Section on Colorectal Surgery to refer a patient requiring a difficult polyp removal.  Physicians for this 70-year-old female patient from the Mayfair section of Northeast Philadelphia had previously noted the polyp on a routine colonoscopy.  The patient had no history of cancer.  On a follow-up colonoscopy the specialist had attempted unsuccessfully to access and remove the polyp.

The polyp, of significant size and unknown pathology, was considered at the very least a precancerous condition, with possible lymph involvement if malignant.  It had imbedded in a difficult-to-reach area of the right colon.

Safeguarding against disease
After meeting with the patient on December 14, and evaluating her records, Robin Rosenberg, MD, FACS, FASCRS, head of Aria’s Section on Colorectal Surgery deemed the lesion likely a premalignant polyp and recommended removing the section of the colon containing the polyp.  The strategy provided greatest safety for removing all abnormal tissue without disrupting it within the body, and thus was most prophylactic against any possible current or future spread of the cancer.  Not wanting to take any chances against a disease like cancer, the patient – who was an otherwise active and healthy senior – agreed to the proposal for a laparoscopically performed, extended right hemicolectomy. 

>> Learn more about single-incision laparoscopy. 
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Undergoing laparoscopy instead of an open surgical procedure would afford the patient all of the advantages of minimally invasive surgery.  The Aria team felt that the patient was a very strong fit to additionally benefit from an improved form of laparoscopy for which it had trained extensively.  Making a single small incision across the navel in which to insert several ports, would permit the team to avoid making multiple incisions around the abdomen for individual access for these ports, which are required for inserting the laparoscope and surgical tools into the body.

Brief hospital stay, fast recovery, no scar.

With group well prepared, procedure goes smoothly
Undertaking the procedure on December 23, Rosenberg led an Aria team – including senior surgical assistant, Elizabeth Matray, PA-C, and nurse anesthetist Evelyn Waddell, CRNA – that has had some 25 years of experience working together as a unit.  They had undergone the extensive training necessary to provide a safe and effective single-incision laparoscopic hemicolectomy – an operation which would be a first for the Aria community. 

With the patient under general anesthesia, the team made a single, two-inch incision vertically across the navel and, through this opening, gained all required access, readily reaching the ascending and transverse colon with the scope and the externally manipulated surgical tools.  The team resected, bagged, and removed the right colon and approximately one half of the transverse colon.  The removal included a lymphadenectomy, performed by excising the fatty tissue adjacent to the mesocolon vessels.


Robin Rosenberg, MD

Rosenberg then restored the bowel, using sutures to anastomize the distal end of the ileum to the remaining length of transverse colon.  The team closed the incision with surgical staples, completing the procedure in less than two hours (notably less that necessary for many multi-incision laparoscopies) and minimal blood loss (no transfusions necessary).

Good results, good news
In the hospital, the patient appreciated less post-operative discomfort than she would have from a multiple-incision laparoscopy.  She moved from a liquid diet to a soft-food diet and was released several days later after her first successful bowel movement.  

Almost as soon she arrived home, she was active again, including shopping, and then driving, and she was free of most dietary restrictions.  By the first of the year (about tens days after her operation), all stiffness in her abdomen had resolved as well.  

The patient returned to the Surgical Specialist Group – Rosenberg’s practice – for follow-up on January 6th, having resumed all normal activities before that time.  Rosenberg removed the sutures from an incision that had healed well and that would leave virtually no scar.

As added good news for the patient, Rosenberg was able to report that the polyp was benign and the lymph tissue negative for disease.  Had the polyp proven cancerous, however, her surgery would still have been regarded as curative.

The patient will undergo a follow-up colonoscopy in three years.