Minimally invasive surgery: colorectal cancers

Surgery is the mainstay treatment for colorectal cancers - malignancies that affect the colon or rectum. In the past, this would mean using one long incision in the abdomen to access the pelvis.

But, with the introduction of minimally invasive surgery (MIS) lots of patients don’t require such invasive measures anymore.

“I prefer calling it minimally ‘access’ surgery because this technique uses multiple small incisions as an entry point to the operation site as opposed to one long cut,” said Dr Ho Kok Sun, a surgeon practising at Mount Elizabeth Hospital in Singapore.

He added that colorectal cancer surgery is generally a pretty challenging procedure because the narrow and confined pelvis offers limited space for dissection.

MIS – also known as laparoscopic surgery – is able to resolve these challenges with the use of smaller and specialised tools that can fit into this confined space.

The tools include a high-definition camera, which provides surgeons with a clearer image of the pelvis.

“Surgeons perform the same procedure that is carried out through traditional surgery with the use of refined instruments and smaller incisions,” explained Dr Ho.

This, in turn, achieves better recovery outcomes, such as decreased pain and scarring. The smaller cuts also reduce the risks of developing infections and the need for post-op pain medications.

In addition to these benefits, patients experience much shorter hospital stay and are able to return to their normal activities much sooner in comparison with traditional surgery.

“After an open surgery, patients tend to feel discomfort and walk slowly weeks after getting discharged, while patients experience the opposite in the days following laparoscopy,” said Dr Ho.

In fact, one of Dr Ho’s patients in his mid-50s was able to start running again seven days after the surgery took place.

Robotic surgery:  a refined tool

Although there are some circumstances where a surgeon’s hand may not be the most efficient tool to treat colorectal cancers, these problems can be overcome by another minimally invasive technique called robotic surgery.

“This technique involves manoeuvring a robotic arm with attached instruments inside the body to mimic a surgeon’s hand gestures,” Dr Ho explained.

He emphasised that robotic surgery offers significant advantages in treating low rectum cancers, where surgeons have to operate deep inside the pelvis.

“It allows more flexibility and finer movements, so surgeons are able to do more precise work inside a limited space,” he said.

Additionally, the 3D camera provides an improved and magnified vision that allows surgeons to carefully identify and preserve sensitive pelvic nerves. Nerve damage is a common complication associated with laparoscopy and open surgery that may lead to sexual dysfunctions.

Limitations of MIS

MIS is not recommended to treat any type of colorectal cancers.

For example, big tumours require open surgery because they cannot be pulled out through small incisions.

This was the case for one of Dr Ho’s patients who had a 20-centimetre tumour in her colon. Her only option was to have a large abdominal cut to extract the tumour.

Similarly, open surgery is required when tumours spread to surrounding organs. In this situation a big cut allows surgeons to clear all cancer tissues thereby minimising the risk of relapse.

Dr Ho Kok Sun is a general surgeon practising at Mount Elizabeth Hospital in Singapore. He specialises in treating colorectal diseases and has a strong expertise in minimally invasive colorectal surgeries.

Ho Kok Sun Colorectal Pte Ltd
3 Mount Elizabeth #12-09
Mount Elizabeth Medical Centre
Singapore 228510
Tel: (+65) 67372778
www.mountelizabeth.com.sg