Laparoscopic Surgery / Minimally Invasive Surgery (MIS)

What is Laparoscopic Surgery?

Laparoscopic surgery is surgery performed on the abdomen or pelvis through several small incisions 0.5-1cm in size. A camera attached to a long thin telescope (laparoscope) is used to allow the surgeon to visualise the inside of the abdominal cavity. Then utilising small instruments placed through the other incisions the surgeon can complete the operation. It is often referred to as Minimally Invasive Surgery (MIS) where the operation is performed with the least amount of surgical stress.

In abdominal surgery, MIS may refer to an operation being performed laparoscopically or robotically. Robotic surgery is a newer technique very similar to standard laparoscopic surgery but involving the surgeon manipulating a robot to move the surgical instruments.

MIS has been performed with increasing frequency and expanding indications over the last 20 years. Laparoscopic surgery was first used in gynaecology and then expanded to gallbladder surgery in 1985. Since this time, the amount of surgery performed as MIS has expanded to more complex and difficult procedures such as colon and rectum surgery. Many surgeons have now been trained to offer MIS to their patients.

What are the potential benefits of Minimally Invasive Surgery (MIS)?

As the incisions are much smaller than traditional surgery, patients typically have less pain following surgery. This can lead to a shorter time in hospital and faster recovery. There is also an earlier return to normal activities with less visible scarring. There may also be less long term problems compared with traditional open abdominal surgery such as adhesions (which can lead to obstruction) and hernias. Long-term outcomes are however similar between both techniques and the evidence supporting the benefit of MIS is in short-term outcomes.

Is Minimally Invasive Surgery (MIS) safe?

MIS has been extensively studied and is safe. The risks and complications are quite similar to traditional open surgery but the specific risk profile depends on the type of surgery and the condition being treated. It is important to discuss with your surgeon whether MIS is appropriate for you. Not all conditions and not all patients can be treated with MIS.

What colon and rectal operations can be performed using Minimally Invasive Surgery (MIS)?

Most operations performed for colon and rectal surgery can be performed using MIS. This includes cancer surgery, although the evidence is stronger for the benefits in colonic surgery.
Other factors may impair the ability of your surgery to be performed by MIS. These include the preference and experience of your surgeon, your surgical history and other characteristics such as the extent of the disease being treated (eg amount of inflammation or size of the cancer). These factors are all taken into account by your surgeon to individualise the best treatment for you.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.