The Evolution of Laparoscopy

For most colorectal diseases and disorders that require a minimally invasive abdominal operation, laparoscopy is the approach of choice because of its benefits and comparable outcomes to open
surgical procedures.

"Laparoscopy, which typically requires three or four incisions, has evolved to a single-incision surgery," says Daniel Geisler, MD, a surgeon in Cleveland Clinic’s Department of Colorectal Surgery.  "Single-incision surgery represents the bridge to the future because it should enable us to develop natural
orifice surgery."

In 2007, Feza H. Remzi, MD, performed the world’s first single-port laparoscopic colon resection.  The procedure removed the patient’s colon entirely through an incision in the umbilicus (belly button).

Drs. Remzi and Geisler performed the single-port laparoscopic colorectal surgery using a Uni-X™ Single-Port Access Laparoscopic System, a multi-cannula laparoscopic port and specially designed curved laparoscopic instrumentation.  The abdomen was approached through a 3.5-centimeter incision via the umbilicus and single-port access device was utilized to perform a right hemicolectomy on a patient with an unresectable caecal polyp.  The patient had a body mass index of 35. Ligation of the ileocolic artery was done with a LigaSure Device and was followed by colonic mobilization, extraction and extracorporeal ileocolic anastomosis.

The operative time was 115 minutes with minimal blood loss. Hospital stay was four days with no
undue sequelae.

In June 2009, Dr. Geisler performed the world’s first total proctocolectomy and ileoanal pouch procedure using the single-incision, laparoscopic technique on a 13-year-old patient with familial adenomatous polyposis (FAP).  The procedure will significantly reduce the patient’s risk of colon cancer.

"Not only does the single-port procedure deliver the usual benefits of quicker healing and less pain with less visible scarring, but it also should lower the risk of developing scar tissue and related bowel obstructions later in life, similar to what has been documented using laparoscopic techniques," Dr. Geisler says.  "Dramatically better chances of having normal bowel function, better sexual function and greater fertility (especially) for females also are expected."