The latest advances in minimally invasive colorectal surgery

As surgeons, it's our responsibility to learn and develop new techniques that can continually improve outcomes and quality of life for patients.

And in the field of colorectal cancer surgery, we have seen great success. For many years, the best way to advance surgical techniques was to improve the location and sizing of incisions. But now, as the tools at our disposal become more advanced, so do our capabilities. Our knowledge of the intricacies of the human body has also developed, providing a successful equation for significant improvements in the outcomes of many surgeries. For early-stage diagnoses of colorectal cancers, the nationwide survival rate has risen to 90%. And for many of these patients, life will continue without a colostomy bag – an unfortunate fate that was all-but-certain just a few years ago. One of the biggest factors for this improvement is the expanded use of minimally invasive and robotically assisted surgeries.

Changing the way we look at surgery
The safest surgeries are the ones the operating surgeon feels most comfortable performing. That's why continuing education is beneficial to surgeons looking to learn and gain comfort with the latest techniques. Doctors coming into the field are now being taught ground-breaking techniques and, as a result, they are more comfortable with advanced practices than their more senior colleagues for whom new techniques may not yet be routine.

Unfortunately, patients are largely unaware of options that could have better outcomes for them, and don't often seek second opinions. While open surgery may still be the best option for some patients, elite doctors are now performing a majority of their operations laparoscopically. Reducing incision size decreases surgery length and recovery time, with equivalent or better surgical outcomes. Yet, even as these techniques become more widespread, there are even more advanced techniques on the horizon.

Pioneering minimally-invasive techniques
The majority of current surgical techniques require damaging a healthy organ, such as the skin or abdominal muscles, to get to the area which needs a surgical fix. This is counterproductive to the end goal, as the more damage caused in-process, the more the patient's body has to overcome for a full recovery. Finding ways to minimize that damage is paramount to improving overall outcomes. At Lankenau, we have widespread experience with robotic surgeries in the fields of cardiology, and gynecology, as well as in thoracic and colorectal procedures. Colorectal surgeries in particular provide a unique opportunity to utilize a natural orifice, such as the anus, as an access point to damaged or diseased tissues. Two of the most advanced current techniques in the area of colorectal cancer surgery are the TATA procedure and the NOTES technique.

TATA, or Transanal Abdominal Transanal Radical Proctosigmoidectomy with Coloanal Anastomosis, was a revolutionary technique developed by my father, Dr. Gerald Marks, and first performed in 1984. The process and tools have evolved over the years, but TATA surgeries remain at the forefront of colorectal surgery technique. For the TATA, a laparoscope is inserted through a small (typically ½ inch) incision in the abdomen, with any additional tools that may be required being inserted through the rectum. In some cases, supplementary incisions may be required. However, by avoiding any major unnecessary cuts, the chances of preserving the sphincter are significantly increased, and the likelihood of patients needing colostomy bags is considerably reduced.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a culmination of the latest advances in minimally-invasive techniques. For a NOTES surgery, both a camera and the surgical instruments are inserted through the anus, preserving the skin and abdominal muscles. While this technique provides similarly positive outcomes to other surgeries, the patient' s resulting recovery and hospital stay times are greatly decreased, lessening the likelihood of peripheral issues and reducing the overall cost to the healthcare system. While current technology limits the areas of the body that are accessible using this type of technique, new tools are being developed that will allow surgeons to push further into the abdomen. The benefits of incision-free surgery are undeniable, and similar surgeries will soon become the standard.

Where the future is taking us
In the not-too-distant future, doctors will be performing all of their surgeries in minimally-invasive fashions. In fact, I expect that within 20 years we'll see widespread use of surgeries that don't require a scalpel at all. Advanced tools provide better control, clearer imaging, and more capabilities than ever before – all leading to a better surgical experience for both the surgeon and the patient.

Robotically-assisted and remote surgical techniques will also allow doctors to provide better outcomes, regardless of location. No longer will patients' access to surgeons be dependent on geography – they'll be able to choose the surgeon who offers the best treatment for their unique situation, and then have the procedure performed at their local hospital. And the added speed and convenience that these procedures provide, when compared to open techniques, means that doctors will be treating more patients, with better outcomes, without raising overall healthcare costs.

Despite the effectiveness of these techniques, no operation can replace encouraging appropriate screening and prevention. We are entering an age where advanced surgical techniques are offering patients better outcomes than ever before, regardless of the progression of their disease. These procedures will continue to advance if experienced doctors with patient knowledge, and younger doctors with advanced training, continue working together to develop better options for patients. Today's doctors owe it to their patients to consider the latest techniques and advancements to provide the best possible care. And sometimes, we must be willing to admit that a referral to a second opinion is the best option for the patient.

The surgeries being performed today are laying the groundwork for a bright future – where surgeries may be completed without any incision at all, and patients can experience the best quality of life possible. It's an exciting time to be in the field.

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