Roberto Bergamaschi, MD, PhD, professor of surgery and chief of colon and rectal surgery, is a world-renowned colorectal surgeon and an internationally recognized expert in laparoscopic surgery for colorectal diseases. He was among the very first colorectal surgeons in the U.S. to have mastered laparoscopic colorectal surgery, and here he provides answers to questions about it.
Q: What options do I have for colorectal cancer surgery?
A: A patient undergoing surgery for colorectal cancer has three options — conventional open surgery, laparoscopic-assisted surgery, or laparoscopic surgery. Conventional open surgery requires a large incision in your abdomen to remove cancerous tumors and any nearby lymph nodes.
One of the downsides of this option is, in most cases, the development of significant scar tissue inside the abdomen over time. Two other known disadvantages are that the incision may cause a hernia and infection can occur where the incision was made in the skin.
Laparoscopic-assisted surgery involves the use of a slender viewing tube (laparoscope) and a tiny camera, which are inserted through the navel to examine the abdominal organs and perform surgery. With laparoscopic-assisted surgery, the incision in the abdomen is smaller than the one used in open surgery, but large enough that the colon can be lifted through it, so the surgery can be performed outside the body.
Laparoscopic surgery, also known as minimally invasive surgery, is performed entirely inside the body (hence, the term “intracorporeal”). It is an advanced procedure that is a safe and effective alternative to both conventional open surgery and laparoscopic-assisted surgery.
Q: What are the benefits of intracorporeal laparoscopic colorectal surgery?
A: Greater vision, control and accuracy for surgeons: An important point to consider is that with laparoscopic-assisted surgery, the surgeon’s line of vision inside the body is limited. This is because the incision that is made is minimal for thelaparoscope to remove the colon from the body to perform the surgery.
As a result, the surrounding area inside the body cavity is not readily visible to the surgeon, which limits the number of lymph nodes that can be removed.
However, in intracorporeal laparoscopic surgery, the incision, while small, is large enough to enable the laparoscope to travel further into the body cavity and view the area surrounding the colon at two times the magnification level.This helps ensure that all the lymph nodes are removed during colorectal cancer surgery.
Fewer post-operative risks: Though both conventional open surgery and laparoscopic-assisted surgery are safe and common procedures, there is less bleeding, less risk of infection, less pain and less scarring for the patient who undergoes the intracorporeal laparoscopic procedure. To avoid the risk of adhesions, which can lead to small bowel obstruction years or decades after surgery is performed, intracorporeal laparoscopic surgery is recommended.
Q: What role does robotics play?
A: Robotic technology virtually extends the surgeon's eyes and hands into the narrowest confines of the colon or rectum. At Stony Brook, the da Vinci® S HD™ Surgical System is used to perform this procedure. It's a high-tech 3D endoscopic system with state–of–the–art robotic technology that is positioned above the operating table and controlled by the surgeon from a special station in the operating room.
Using the flexible “wrists” of the da Vinci robot, the surgeon is able to delicately pass a two-lens camera for 3D viewing laparoscopically through one of the ports in the skin. Wristed instruments that bend up and down and allow freedom of movement can also be passed through one of the tiny incisions in the skin.
Q: What is Stony Brook's expertise in intracorporeal laparoscopic colorectal surgery?
A: Because intracorporeal laparoscopic colorectal surgery takes place entirely inside the body, it requires extensive and highly specialized training. Few colorectal surgeons are qualified to perform this procedure — there are only a handful of us in the U.S. Stony Brook is one of the few centers on Long Island to perform this advanced procedure.
At Stony Brook School of Medicine, I lead an extensive one-year residency program to ensure that we have a growing number of colorectal surgeons on our team who are qualified to perform intracorporeal laparoscopic surgery. As a result, patients with colorectal cancer on Long Island no longer have to travel hours away for this high-tech procedure.
Read about our use of robotics to perform colorectal surgery. At Stony Brook, we are committed to using the latest technology to lead the way in patient care.