Laparoscopic (keyhole) colorectal surgery

Laparoscopic colorectal surgery avoids the need for a long incision (cut) in the abdomen (tummy). This causes a lot less pain from the wound after the operation. It also means you:

• stay in hospital for a shorter time (a matter of days)

• can return to normal activities in a few weeks

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is the colon and rectum?

The colon and rectum refers to the large intestine or bowel. It forms the lowest part of the digestive system after the small bowel, and it ends at the anus.

What is laparoscopic surgery?

Laparoscopic surgery is also known as ‘keyhole’ surgery. It allows the surgeon to carry out operations through four or five small (1cm) cuts in the abdomen. The surgeon places a telescope camera into one of these small cuts. The camera shows an enlarged image (picture) of the abdominal organs on a television screen. The surgeon then uses the other cuts to insert the special instruments needed to carry out the surgery.

In some cases, the surgeon can make one of the cuts longer (8 to 10cm). This allows the surgeon to remove a bowel specimen (sample).

What are the benefits of laparoscopic surgery rather than open surgery?

Open surgery involves one large incision (cut). The common advantages of having laparoscopic rather than open surgery, include the following.

• Less pain after the operation.

• A shorter hospital stay.

• A quicker return to eating, drinking, and bowel function (going to the toilet normally).

• A quicker return to normal activities.

• Less scarring after the operation.

Results vary depending on the type of procedure you need and your condition.

Can I have laparoscopic colorectal surgery?

It is not always possible for every patient to have laparoscopic surgery. Your surgeon has to look at each case individually. You will need to discuss this type of surgery with your surgeon to find out if this is the best option for you.

How should I prepare for my surgery?

You will have the same investigations and tests before your operation as patients who have ‘open’ surgery. These tests:

• confirm your diagnosis

• confirm the extent of the disease

• assess how fit and well you are for the proposed treatment

How is laparoscopic colorectal surgery performed?

Through a small cut (often close to your tummy button), your surgeon will:

• place a cannula (a hollow needle-like tube); and

• pass gas (carbon dioxide) through this.

The gas fills your abdominal cavity. It makes space, so your surgeon can place a laparoscope (a narrow telescope joined to a video camera). Through the laparoscope your surgeon can see a magnified view of your abdominal organs on a television screen.

The remaining cuts allow your surgeon to place operating instruments inside your abdomen, so they can carry out the operation. If your surgeon is removing part of your bowel, they will make one of these cuts larger.

The surgery usually takes 2 to 3 hours.

What happens if my operation cannot be carried out or finished using the laparoscopic method?

For some people the laparoscopic method cannot be performed safely or well enough.

Below are some of the issues that may increase the possibility of choosing or changing to ‘open’ surgery during the operation.

• Being very overweight.

• A history of abdominal surgery, which has caused a lot of scar tissue.

• The surgeon cannot see your organs clearly.

• Bleeding problems during your operation.

• Large tumours.

Your surgeon will decide to carry out surgery using the open procedure either before or during your operation. Be prepared for the possibility that your surgeon may have to go back to open surgery during your operation.

What should I expect after my surgery?

For the first 24 to 48 hours after surgery you will need the following.

• Oxygen through a face mask.

• Intravenous (IV) fluid using a cannula (drip) into a vein in one of your arms.

• A catheter in your bladder to drain urine.

• Medication to deal with mild pain.

Over the next few days you will need to:

• start eating a modified diet, starting with liquids, gradually followed by solid foods

• move round as soon as possible

Produced with grateful acknowledgement to The Association of Coloproctology of Great Britain and Ireland (ACPGBI).

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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