- Smaller Incisions: The procedure requires only 3-5 small incisions rather than one large abdominal incision, resulting in less post-operative pain and improved cosmetic outcomes.
- Faster Recovery: Patients typically experience shorter hospital stays and can return to normal activities more quickly than with open surgery.
- Reduced Complications: The minimally invasive approach leads to lower rates of wound infections and post-operative hernias.
- Enhanced Visualisation: The laparoscopic camera provides magnified views of the surgical area, allowing for precise dissection and tissue handling.
Laparoscopic Hemicolectomy
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Laparoscopic hemicolectomy is a minimally invasive surgical procedure that removes a portion of the colon using small incisions and specialised instruments. The surgeon operates through 3-5 small incisions in the abdomen, using a camera (laparoscope) and surgical tools to remove the affected segment of the colon and reconnect the healthy ends.
Indications for Laparoscopic Hemicolectomy
Several medical conditions may require a laparoscopic hemicolectomy as determined by clinical assessment and diagnostic testing. These include:
- Colorectal Cancer: Removal of cancerous tumours located in either the right or left colon, along with surrounding lymph nodes for proper staging and treatment.
- Large Polyps: Removal of large, potentially pre-cancerous polyps that cannot be removed through colonoscopy.
- Inflammatory Bowel Disease: Treatment for severe cases of Crohn’s disease or ulcerative colitis affecting specific segments of the colon that have not responded to medical management.
- Diverticular Disease: Management of recurring diverticulitis or complications such as fistulas or strictures in the affected segment of the colon.
Benefits of Laparoscopic Hemicolectomy
Laparoscopic hemicolectomy offers distinct advantages compared to traditional open surgery methods.
Surgical Techniques
The specific approach to laparoscopic hemicolectomy varies based on the location of the disease and patient factors.
Right Hemicolectomy
This procedure removes the right side of the colon, including the caecum, ascending colon, and part of the transverse colon. The small intestine is then connected to the remaining transverse colon. The surgeon carefully manages the right-sided blood vessels and supporting tissues (mesentery) during the procedure.
Left Hemicolectomy
This technique involves removing the left side of the colon, including part of the transverse colon and descending colon. The procedure requires precise dissection of the left-sided blood vessels and the area near the spleen (splenic flexure). The remaining transverse colon is connected to the sigmoid colon.
Extended Hemicolectomy
This variation removes a larger portion of the colon when disease extends beyond standard resection boundaries. The surgeon removes additional segments of the transverse colon and adjusts the reconnection points based on the extent of resection.
Surgery Preparation
Medical Assessment
A complete physical examination, blood tests, and imaging studies are performed. The surgeon reviews medical history, current medications, and any pre-existing conditions that may affect surgery outcomes.
Medication Management
Blood-thinning medications are typically stopped 5-7 days before surgery. Specific instructions for diabetes medications and other regular prescriptions are provided based on individual needs.
Bowel Preparation
Patients follow a clear liquid diet 24-48 hours before surgery and take prescribed bowel cleansing solutions. Complete bowel emptying helps reduce infection risk and facilitates the surgical procedure.
Fasting Guidelines
No food or drink is allowed for 8 hours before surgery, except for approved medications with small sips of water.
Step-by-Step Procedure
Anaesthesia Administration
General anaesthesia is administered, and the patient lies on their back with arms extended. The surgeon ensures proper monitoring equipment placement and access to the surgical field.
Port Placement
The surgeon creates 3-5 small incisions in the abdomen for inserting surgical ports. Carbon dioxide gas is used to inflate the abdomen, creating space for instrument manipulation and clear visualisation.
Colon Mobilisation
The affected portion of the colon is carefully separated from surrounding tissues using specialised instruments. Blood vessels supplying the segment are identified, clipped, and divided.
Bowel Resection
The diseased segment of the colon is divided using surgical staplers. The specimen is placed in a retrieval bag and removed through one of the port sites, which may be slightly enlarged.
Anastomosis
The remaining healthy ends of the colon are reconnected using surgical staplers or sutures. The connection is tested for leaks using air insufflation and/or dye testing.
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Post-Surgical Care and Recovery
- Immediate Post-operative Care: Patients are monitored in a recovery room for vital signs, pain control, and early complications. Intravenous fluids and pain medication are administered as needed. Most patients stay in hospital for 3-5 days.
- Recovery Process: Patients begin walking within 24 hours of surgery and gradually advance from clear liquids to solid foods. Pain medications are transitioned from intravenous to oral forms as recovery progresses.
- Follow-up Care: The first post-operative visit occurs 1-2 weeks after discharge. Subsequent visits are scheduled based on the underlying condition and recovery progress. Work resumption typically occurs within 4-6 weeks.
Potential Risks and Complications
The risks of laparoscopic hemicolectomy include bleeding, infection, and anaesthesia-related complications. Specific risks include anastomotic leak, bowel obstruction, and injury to nearby structures. Some patients may require conversion to open surgery if technical difficulties arise during the procedure. Long-term complications can include adhesions, incisional hernias, and changes in bowel habits.
Frequently Asked Questions
Will I need a stoma after surgery?
Most patients do not require a temporary or permanent stoma after laparoscopic hemicolectomy. However, in some cases, such as emergency surgery or complex disease, a temporary stoma may be created to allow the bowel connection to heal safely.
When can I resume exercise after surgery?
Light activities like walking can begin immediately after surgery. Gradual progression to more strenuous activities occurs over 6-8 weeks. Contact sports and heavy lifting should be avoided for at least 12 weeks.
How does the surgeon decide between laparoscopic and open surgery?
The decision depends on factors including previous abdominal surgeries, body mass index, extent of disease, and overall health status. Some conditions, such as large tumours or extensive inflammation, may require an open approach.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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Singapore 329563
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