Digest This - Special Edition 2008 - (Page 4)

cleveland clinic single-port colectomy Believed to Be First in World Delivering less-invasive options is ongoing goal at Cleveland Clinic Cleveland Clinic Digestive Disease Institute surgeons, continuing in their commitment to offer less invasive surgical options to their patients, have recently performed what they believe to be the world’s first single-port colectomy. The procedure, performed by Daniel Geisler, MD, and Feza Remzi, MD, was completed in December 2007 on a 72-year-old woman who had large colon polyps. She recovered well from the procedure and was released from the hospital four days later. “She had just one small incision which was about 4 cm long and since most of it is in the navel, you can barely see it,” explains Dr. Geisler. “She is very pleased with both her medical and cosmetic outcome, as are we.” The conventional laparoscopic approach to this procedure involves three to five small abdominal wall incisions. The Single-Port Laparoscopic (SPL) trans-umbilical approach employed by Drs. Remzi and Geisler uses only a single umbilical incision through which a single specially designed port is placed. There is no utilization of any other accessory ports inside or outside the umbilicus. Prior to the development of laparoscopic surgery, a conventional colon resection would have required a foot-long incision. other organs, such as kidneys and gallbladders, have been treated with single-port technology, but these Cleveland Clinic surgeons believe their colon procedure to be a first. Their report on it has been accepted for publication in Colorectal Disease. “We expect outcomes with single-port technology to be even better than with existing laparoscopic techniques because we are reducing the number of incisions, which of course leads to faster healing with less pain and discomfort,” Dr. Geisler says. While Natural Orifice Transluminal Endoscopic Surgery, often referred to by the acronym noTES, is a trend in surgery today, he explains that Cleveland Clinic surgeons are committed to pursuing “E-noTES” – utilizing an embryological orifice, such as the navel, as the entry point. “We are actively pursuing less and less invasive surgery and this is the next logical step,” he explains. “To our knowledge, we are the first to present umbilical NOTES surgery through a single port and the first to report a formal colon resection through a single port.” The operation was performed using the Uni-X Single Port Laparoscopic System, a single multi-cannula laparoscopic port, and a variety of curved laparoscopic instruments. Dr. Geisler explains that several manufacturers are working to keep up with the ever-increasing demands from surgeons for less-invasive options. “There is much research being done to devise unique ports for each individual organ of the body and we are furthering this development through research here,” he says. “We have done ample study on single-port or single-access surgery, particularly through embryological entry points, to help allow us to deliver what is truly the least invasive option for patients.” HELPInG yoUnGER PATIEnTS Dr. Daniel Geisler Cleveland Clinic Digestive Disease specialists are also committed to delivering similarly improved outcomes to patients being treated for familial adenomatous polyposis or irritable bowel disease with a total colectomy or creation of a J-pouch. Many of these patients are younger, and some are not even experiencing symptoms, so accepting the need for a life-changing surgery is difficult. As with colectomy, treatments for these patients once required foot-long incisions, but advances in laparoscopy now allow them to be done with three small incisions and one that is 3.5 to 4 cm long. Not only does this deliver the usual benefits of quicker healing and less pain with less visible scarring, but these patients then run a much lower risk of developing scar tissue and related bowel obstructions later in life. They also experience dramatically better chances of having normal bowel function, better sexual function and, especially for females, greater fertility. “These are benefits that are often overlooked, but they are very important to the future quality of life of these young people. Anything we can do to reduce their morbidity and give them more freedom to live a normal life is worth it,” Dr. Geisler concludes. For more information, email digestthis@ccf.org {4} Digest This Special Edition | 2008

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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