Today surgeons successfully treat both benign and malignant colorectal conditions with MIP for colon surgery.

These include:

• Colon and rectal resections
• Pouch operations
• Ostomy construction
• Combination surgeries involving pelvic procedures such as hysterectomy

The benefits of laparoscopic colectomy, when performed by an experienced surgeon, are now widely recognized thanks to the results of an important three-year multicenter study. Published in the New England Journal of Medicine in 2004, this study (N=872) found that for treating colon cancers, a minimally invasive technique provided equivalent recurrence and overall survival rates as the traditional open colectomy approach. Complication rates were also comparable.

Patient demand for less traumatic surgeries is also fueling the more widespread use of MIP for colon surgery. Compared to open surgery, patients treated with a laparoscopic colectomy performed by an experienced surgeon may experience:

• Shorter hospital stay
• Shorter recovery period until work and other activities can be resumed
• Less scarring and better aesthetic results
• Shorter duration of pain

The critical steps of both open colon resection and laparoscopic colectomy are essentially the same:

• In an open colectomy, the surgeon makes an incision up to 12 inches long from the upper to lower abdomen. This invasive approach usually warrants a one-week-plus hospital stay and a recovery period of six to eight weeks.
• During a minimally invasive laparoscopic colectomy, the surgeon makes a series of small abdominal incisions, ranging from one quarter of an inch to four inches.

A small videoscope is placed in one incision, which provides the surgeon with a magnified view of the patient's internal organs on a monitor. Surgical instruments are placed in the other incisions, allowing the surgeon to access and remove appropriate portions of the colon and restore function. With laparoscopic colectomy, patients can usually leave the hospital in less than a week and resume normal activity in less than two weeks.

(Flash animation: MIP colectomy versus an open procedure)

The American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons recommend that before treating patients with curable cancer, a surgeon should have performed at least 20 laparoscopic colorectal resections with anastomosis for benign disease or metastatic colon cancer. Other experienced surgeons recommend only laparoscopic surgeons who also perform more than 25 open colectomies annually.

Laparoscopic colectomy is contraindicated in patients with increased bleeding risks. Excessive scar tissue, severe adhesions from a previous laparotomy, and the inability to visualize organs because of tumor bulk are also possible contraindications.

Be sure to discuss surgical risks with your patients.