Minimally Invasive Surgery Improves Outcomes and Experience for Many Colorectal Surgery Patients
Most of us feel uncomfortable talking about colon cancer and other diseases of the colon and rectum. Thankfully, colonoscopy screening and advances in treatment of colon cancer have significantly improved the outcome and have decreased the incidence of colon cancer by 2-3% per year since the mid 1980's. Even people with advance disease are living longer with improved quality of life.
Surgery is often required to treat colon cancer and some other non-malignant conditions of the colon and/or rectum, such as bleeding, arterial venous malformation or infection. For many years, colorectal surgery required a large incision and a lengthy, uncomfortable recovery. Today, some surgeons are using minimally invasive techniques, also called laparoscopic surgery, to decrease post-operative pain and hospitalization time for many colorectal surgery patients. This approach can offer important benefits to both patients and surgeons.
"With minimally invasive surgery, we make very small incisions and use ports, that allow us to do major surgery through the tiniest possible opening," explained Andrea French, M.D., a Fremont-based general surgeon with Washington Township Medical Foundation.
Board certified in general surgery, Dr. French completed an extra year of training as a Minimally Invasive Surgery/Bariatric Surgery Fellow at Alta Bates Summit Medical Center in Oakland and Berkeley. Currently, she practices General Surgery which incorporates a significant amount of minimally invasive surgery including colorectal surgery. She also specializes in solid organ surgery, including laparoscopic removal of the adrenal gland or spleen, and minimally invasive procedures to treat gastroesophageal reflux disease (GERD). In addition, as part of her general surgery practice, Dr. French performs a broad spectrum of other procedures to treat gallbladder disease, hernias and breast abnormalities.
"With minimally invasive surgery, the size of the largest incision is restricted by the size of the tissue we may need to remove. The resulting surgical scars can be so little, they can sometimes be hidden in creases of the patient's belly skin," added Dr. French.
For some patients, the traditional open surgical approach is still recommended. In emergency situations, such as a bowel obstruction or if there is significant scarring from previous abdominal surgeries, doctors may need to take the open approach. Traditional open surgery is also indicated in advanced colorectal disease.
"With traditional surgery, the surgeon makes a large incision from the rib cage down to the pubic bone to get adequate exposure," stated Dr. French.
Most minimally invasive colorectal surgeries are done in the hospital, especially if it is necessary to remove parts of the colon. However, there are times when the procedure can be conducted in an outpatient surgery center, if diseased tissue is positioned low enough it can be removed through the anus, the body's natural orifice.
For patients, minimally invasive colorectal surgery can mean a quicker, easier recovery. The bowel starts functioning faster; they are able to eat sooner; and there is less pain and scarring.
For doctors, the minimally invasive approach is beneficial because it gives them a better field of vision to see tumors and other problem areas more clearly. During surgery, images of the surgical area are transmitted using a tiny camera known as a laparoscope, which is passed through a port into the abdomen. The surgeon views high definition, real-time images on a near-by monitor while performing the procedure.
Today, most surgeons learn minimally invasive techniques during their training. In the Fremont area, long-time local surgeons and members of Washington Township Medical Foundation Ramsey Araj, M.D, and William Dugoni, M.D., have been at the forefront of laparoscopic surgery the last two decades bringing this and robotic surgical technology to the residents in the Tri-City area sooner than in many other communities.
Dr. French and Kranthi Achanta, M.D., another member of the Medical Foundation, learned their techniques during their residency and have also had an extra year of fellowship training. Minimally invasive surgery comprises about 20 percent of the surgeries these doctors perform.
"Nationwide, laparoscopic colorectal surgery is underutilized, mainly because surgeons don't have the necessary skills," said Dr. French. "All four general surgeons in Washington Township Medical Foundation are skilled in laparoscopic surgery, and it is our standard of care for non-emergency cases."
The four surgeons perform approximately 160 minimally invasive colorectal surgeries annually. Washington Township Medical Foundation surgeons work closely with gastrointestinal physicians in the community to see that patients who may need colorectal surgery don't have to wait long to be examined by a surgeon.
"In addition, our office staff is proactive about making sure patients with potentially serious conditions are seen as quickly as possible," commented Dr. French.
The doctors also take a multidisciplinary approach to care, especially for patients with cancer. For example, a Tumor Board made up of physicians from a spectrum of specialties, including oncology, pathology, radiation oncology and surgery, meets to review all the diagnostic information about a patient. Together, the doctors decide the optimum treatment for each individual. This means colorectal surgery patients benefit from the knowledge and expertise of a wide range of specialists.
The good news is that when caught early colorectal cancer is highly curable. Even in more advanced disease, 5 year survival rates exceed 83%. Fortunately, Washington Hospital has all the specialists and support staff to help patients from cancer prevention to treatment in advanced disease.
To learn more about minimally invasive colorectal surgery visit www.sages.org, the Web site of the Society of American Gastrointestinal and Endoscopic Surgeons. To learn more about Dr. Andrea French and the Washington Township Medical Foundation, go to www.mywtmf.com.