Minimally Invasive Surgery
Minimally invasive surgery refers to several techniques and technological advances that are all designed to minimize the physiologic impact of surgery, without sacrificing the results of surgery. Laparoscopic surgery is practically synonymous with the term minimally invasive surgery; however, minimally invasive surgeries include also robotic surgery and TAMIS. All of our surgeons are highly-trained laparoscopists and this is our preferred approach. We are also well versed in robotic surgery and TAMIS.
TAMIS stands for TransAnal Minimally Invasive Surgery. TAMIS was pioneered in 2009 as a hybrid technique for trans-anal resection of appropriately selected rectal lesions, such as polyps, carcinoid tumors, and under some circumstances, early rectal cancers. It was initially developed by using a single access port designed for abdominal laparoscopic surgery and placing it into the anal canal. By gently filling the rectum with air the surgeon is able to navigate higher up into the rectum to remove rectal lesions that previously would have required a major abdominal operation. Because of improved visualization and instrumentation with this technique, our ability to remove rectal lesions effectively, completely and safely has been dramatically improved.
Surgical treatment for distal rectal cancer requires a high-level technical skills and knowledge because of these tumors intricate relationship to the anal sphincter muscle and sexual organs. For years, treatment of cancer in the lower rectum often resulted in a permanent stoma or colostomy. A stoma is an opening made in the abdominal wall where the colon is connected to and the stool is collected in a bag. However, advanced surgical techniques have been developed which in many cases can remove tumors and “spare” the anal sphincter muscles thus preserving normal bowel function.
Preoperative staging, evaluation and adequate patient selection are critical for successful rectal cancer surgery. California Colorectal Surgeons use a multidisciplinary approach in treating and evaluating rectal cancer cases and develop an individual care plan for each patient. The team includes gastroenterologists, radiologists, pathologists, radiation oncologists, medical oncologists and colorectal surgeons. Their combined input can determine if he or she is a candidate for sphincter-sparing surgery.
Techniques for Sphincter-sparing surgery include:
- Neoadjuvant therapy
This therapy consists of administering radiation and chemotherapy as an outpatient before surgery in order to shrink very large or advanced tumors. After the neoadjuvant therapy has been completed, the surgeon waits 6-8 weeks to allow maximum shrinkage of the tumor. This treatment greatly reduces the recurrence rate of the tumor and improves chances of avoiding a stoma.
- Local excision
- Coloanal J-Pouch
The rectal tumor is removed close to the sphincter muscles. A pouch is then created from the colon above and attached inside the lower rectum or anal canal. The pouch improves storage capacity and bowel function or control after surgery.
- Laparoscopic Surgery
- Robotic Surgery