Laparoscopic total colectomy

[elsi]

I have been referred to surgery to have a laparoscopic total colectomy with ileo-anastomosis, after being diagnosed with colonic inertia and mega colon.  The surgeons I have met with have described different approaches to this laparoscopic prodcedure and have indicated that I am a canidate for which ever laparscopic approach I feel more comfortable with.  Therefore my questions are:
What are the draw backs to the hands assisted laparoscopic procedure wherein the surgeon will make a four inch horozontal incision below the belly button, through which he will isert his hand (and I assume some forearm) throughout the procedure to help mobilize the colon and then later will remove and pull the colon out through that same incision? Further, with the hands assisted approach, the additional instrumentation will be introduced through three 'key whole' entries; one near the belly button and two slightly higher on either side near the obligue area.  In contrast, the non-hands assisted approach uses more key-whole entries (5-6) and often a 3 inch horizontal incision below the belly button to be used just at the end through which to pull out the mobilized colon, but all of the surgical work will be done, therefore, just via the small instruments placed through each cannula.  Does the body incur more trauma when the procedure is done with the 'hands assisted' technique than without?  Is the hands assisted generally used by surgereons who are not yet truly proficient in a completely laparoscopic approach or is there a significant benefit to the hands assisted, even though it seems so much more invasive.  I understand the O.R. time is much less with hands assisted, wich is a consideration, but overall it seems much more invasive and traumatic to the body, which is what one is trying to avoid by having laparoscopic surgery.  This is a concern to me especially since I want to have children in the future after an appropriate healing time.  
I would greatly appreciate any information you may offer at your earliest convenience as the surgical dates they have set asside for me are in March and I need to make a decsion quickly, and I want it to be the right one.  Thank you so much for your help.
Sincerely, Elsi

[Sue357]

A related discussion, hand assisted lapro colon resection was started.

[JAJA03]

Hello Elsi.. I have had the same surgery that you are thinking about having 3 years ago when I was 17 yrs. old and believe it or not for the same reasons you mentioned.. then a year later I had gallbladder removed because I had developed an infection... The only thing that I can tell you is that after the surgery your body is going to go through and adjusting period which can last up to 18 months, your body has to figure out which food it will accept or reject.. it's all up to your body even if your head tells you, i can eat it, then you'll learn you can't once your body rejects it by "not keeping" it down... Also after surgery from that point on your immune system will be easier for you to catch different infections dealing with the abdomen just because your colon's not there.. But that think does a lot of work..

[surgeon]

When there are more than one way to do a procedure, it's because none is perfect. Laparoscopy has become the standard way to do several operations, especially gallbladder and hiatal hernia (however, it's not well-known that a so-called "mini-cholecystectomy" compares in every way to laparascopic cholecystectomy in terms of pain, recovery time, return to work, etc, while having fewer complications and very much less cost.) With colon surgery, the main advantage is eliminating a large incision; so much of that is lost with the hand-assisted procedure. It's relative. Some claim more rapid recovery, for example return to eating, after laparoscopy. But it's also been found that you can resume eating earlier than was thought, after any type of procedure.  The other option, of course, is an open procedure, which, in most hands, would subject you to up to several hours less anesthesia time. There is some chance of needing to open after any laparascopic operation.  I happen to prefer open surgery for most colon procedures, but that's in part because I've learned to do it through much smaller incisions than most use, and my patients are in the hospital less time than those who undergo laparascopic procedures. I think there is a need for more time and more data to determine the relative advantages of the three approaches to colon surgery; and it's of course true that the outcome of any one procedure is unpredictable. Meaning that studies of hundreds of cases don't allow predictions to be applied to any individual. So it boils down to hearing what your doctors have to say, asking questions, and choosing what sounds best to you. It seems to me that the main choice is between open or fully closed laparoscopy; the hand-assisted procedure sort of has the disadvantages of both. But that's one surgeon's opinion; there are many other opinions out there, and many, many excellent surgeons. In addition to which, I'm just a guy who posts here when I think I can add something. Dr. Pho is the official answerer, and you'll hear from him, too.

[Kevin Pho, MD]

As I am not a surgeon, I do not have the experience nor information necessary to answer this question.  Our surgical colleague has graciously offered his thoughts in the comments below, and I would agree with his opinion.  

His comments are reprinted here:

"When there are more than one way to do a procedure, it's because none is perfect. Laparoscopy has become the standard way to do several operations, especially gallbladder and hiatal hernia (however, it's not well-known that a so-called "mini-cholecystectomy" compares in every way to laparascopic cholecystectomy in terms of pain, recovery time, return to work, etc, while having fewer complications and very much less cost.) With colon surgery, the main advantage is eliminating a large incision; so much of that is lost with the hand-assisted procedure. It's relative. Some claim more rapid recovery, for example return to eating, after laparoscopy. But it's also been found that you can resume eating earlier than was thought, after any type of procedure. The other option, of course, is an open procedure, which, in most hands, would subject you to up to several hours less anesthesia time. There is some chance of needing to open after any laparascopic operation. I happen to prefer open surgery for most colon procedures, but that's in part because I've learned to do it through much smaller incisions than most use, and my patients are in the hospital less time than those who undergo laparascopic procedures. I think there is a need for more time and more data to determine the relative advantages of the three approaches to colon surgery; and it's of course true that the outcome of any one procedure is unpredictable. Meaning that studies of hundreds of cases don't allow predictions to be applied to any individual. So it boils down to hearing what your doctors have to say, asking questions, and choosing what sounds best to you. It seems to me that the main choice is between open or fully closed laparoscopy; the hand-assisted procedure sort of has the disadvantages of both."

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.