Colorectal Surgery

Robotic colorectal surgery uses a high-tech system to help surgeons operate on the colon and rectum through small incisions. This often means less pain, smaller scars and faster recovery compared to traditional open surgery. The surgeon controls robotic arms with special instruments from a nearby console, offering enhanced precision and a 3D view inside the body. This advanced approach can be used for various conditions, including cancer, diverticulitis and inflammatory bowel disease. Talk to your doctor to see if robotic surgery is right for you.

ERAS, or Enhanced Recovery After Surgery, is a team approach to help you get back on your feet faster after colorectal surgery. It involves specific steps before, during and after your operation. These may include things like drinking a special carbohydrate drink before surgery, early movement after surgery, and managing pain with fewer narcotics. The goal is less discomfort, a quicker return to eating and walking, and potentially a shorter hospital stay. Your doctors, nurses and other healthcare providers will work with you to follow this plan.

High-resolution anoscopy is a detailed way for doctors to look at the lining of the anus and identify abnormal cells called anal intraepithelial neoplasia, or AIN. Think of it like using a special magnifying glass with a light. During the procedure, a small scope is gently inserted into the anus. This scope allows the doctor to see the tissue clearly on a monitor. If any abnormal areas are seen, the doctor can take small tissue samples, called biopsies, to check them under a microscope.

For AIN, high-resolution anoscopy is often considered the most thorough way to find and treat these precancerous cells. If AIN is found, the doctor can use various techniques during the same procedure to remove or destroy the abnormal tissue. This might involve using a small loop with an electrical current, called loop electrosurgical excision procedure (LEEP), or applying a special medication. Treating AIN can help prevent it from turning into anal cancer.

The procedure is typically done in the doctor's office and doesn't usually require general anesthesia. You might feel some pressure or mild discomfort. Preparation often involves a simple enema to clean the bowel. Following the procedure, you'll likely receive instructions on how to care for the area. Regular follow-up appointments and repeat anoscopy may be recommended to monitor for any new or returning abnormal cells. High-resolution anoscopy plays a key role in the early detection and management of AIN.

A tumor board is a meeting where a team of doctors and staff who specialize in different areas of cancer care come together to discuss your specific case. Think of it as having a group of experts all focused on figuring out the best treatment plan for you. This board includes oncologists, surgeons, radiation oncologists, pathologists (doctors who examine tissue samples), and radiologists (doctors who interpret medical images like scans), as well as a nurse navigator.  

During a tumor board meeting, your doctors will present details about your cancer, such as the type, stage, and where it's located. They'll review your test results, including imaging and pathology reports. Then, the entire team will discuss the different treatment options available and share their expertise and perspectives. This collaborative approach helps ensure that all possible angles are considered and that the recommended treatment plan is tailored to your individual needs.

For you as a patient, the tumor board provides an extra layer of support and reassurance. It means that multiple specialists have reviewed your case and agreed on the best course of action. While you may not directly attend the tumor board meeting, your primary doctor will share the team's recommendations with you and answer any questions you may have. The tumor board ensures that you are receiving the collective wisdom of a multidisciplinary team, working together to provide you with the most comprehensive and informed care possible.

Sphincter-sparing surgery for rectal cancer is a type of operation that aims to remove the cancerous tumor while also preserving your anal sphincter muscles. These muscles are crucial for controlling bowel movements. In the past, surgery for rectal cancer located close to the anus often required removing the entire rectum and the sphincter muscles, resulting in the need for a permanent colostomy (a surgically created opening in the abdomen for waste to leave the body).

However, with advancements in surgical techniques, including minimally invasive approaches and a better understanding of rectal anatomy, sphincter-sparing surgery is now possible for many patients with low-lying rectal tumors. The goal is to remove the cancer completely while maintaining your ability to have bowel movements in the usual way.

Whether you are a candidate for sphincter-sparing surgery depends on several factors, including the size and location of the tumor, its distance from the anal sphincter muscles, and your overall health. Your surgeon will carefully evaluate these factors using imaging tests like MRI and endoscopic exams. If sphincter-sparing surgery is an option for you, the surgeon will use specialized techniques to remove the tumor and often a small margin of healthy tissue around it. They may also need to remove nearby lymph nodes to check for cancer spread.

While the aim is to preserve bowel function, some patients may experience temporary changes in bowel habits after sphincter-sparing surgery, such as increased frequency or urgency. These issues often improve over time. Sphincter-sparing surgery can significantly improve the quality of life for patients with rectal cancer by avoiding a permanent colostomy while still effectively treating the disease. Your surgeon will discuss the potential benefits and risks with you in detail to determine the best surgical approach for your individual situation.

Sacral nerve stimulation is a treatment option for fecal incontinence, which is the loss of bowel control. It works by gently stimulating the sacral nerves, a group of nerves located in your lower back that help control the muscles in your bowel and anus. Think of it like a pacemaker, but instead of helping your heart, it helps these nerves communicate better with your bowel muscles.

The treatment involves a two-step process. First, you'll undergo a test phase, usually lasting a few weeks. During this phase, a thin wire is temporarily placed near your sacral nerves, typically through a small incision in your buttock area. This wire is connected to a small external device that you wear. The device sends mild electrical pulses to the nerves. You'll be asked to keep a diary of your bowel movements to see if the stimulation helps improve your control.

If the test phase significantly reduces your fecal incontinence, the second step involves a permanent implantation. A small neurostimulator, about the size of a silver dollar, is surgically placed under the skin in your buttock. A thin wire connects this device to your sacral nerves. The neurostimulator then sends continuous, mild electrical pulses to help regulate the nerve signals controlling your bowel function. You can usually control the device with a handheld programmer.

Sacral nerve stimulation is a minimally invasive and reversible treatment. It doesn't involve major surgery on your bowel itself. Many people find that it significantly reduces their episodes of fecal incontinence and improves their quality of life. Talk to your doctor to see if sacral nerve stimulation might be a suitable option for managing your fecal incontinence.

Anal manometry is a simple test used to check how well the muscles in your anus and rectum are working. These muscles, called the anal sphincters, help control bowel movements. The test measures the strength of these muscles and how they respond to different actions, like squeezing or relaxing. It can also assess the sensation in your rectum and the reflexes that help with bowel control.

During the test, a thin, flexible tube with a small balloon at the end is gently inserted into your anus and rectum. This tube is connected to a machine that measures pressure. You'll be asked to perform different actions, such as squeezing your anal muscles as if you're trying to stop a bowel movement, pushing as if you're trying to have a bowel movement, and sometimes coughing. The machine records the pressure changes in your anal canal during these actions.

Anal manometry can help doctors understand the cause of problems like fecal incontinence (leaking stool) or constipation (difficulty passing stool). It can also be used to evaluate how well the anal muscles are working before or after surgery on the anus or rectum. The test usually takes about 20 to 30 minutes and is generally well-tolerated. You might feel some mild pressure or discomfort during the insertion of the tube, but it's not typically painful. The results of the test help your doctor determine the best treatment plan for your specific condition.

Pelvic exenteration is a complex surgical procedure to remove advanced or recurrent cancer within the pelvis. Because the pelvis houses several organs, this surgery involves removing the cancerous tumor along with the organs where the cancer has spread. The specific organs removed depend on the location and extent of the cancer but may include the rectum, colon, bladder, prostate (in men), uterus, cervix, ovaries, and vagina (in women).

This is a significant surgery typically considered when other treatments, like radiation or less extensive surgery, are not sufficient to control the cancer. The goal of pelvic exenteration is to completely remove all cancerous tissue, offering the best chance for long-term survival or improved quality of life when cure is not possible.

Because pelvic exenteration involves removing organs responsible for bowel and/or urinary function, it necessitates creating new ways for waste to leave the body. This usually involves ostomies, where the surgeon creates openings (stomas) on the abdomen for urine (urostomy) and/or stool (colostomy or ileostomy) to be collected in external bags. In some cases, reconstructive surgery may be possible to create a new bladder or vagina using tissue from other parts of the body.

The decision to undergo pelvic exenteration is a significant one and is made after careful evaluation by a team of specialists. They will consider the type and stage of your cancer, your overall health, and the potential benefits and risks of the surgery. While it is a major operation with a long recovery period, for carefully selected patients, pelvic exenteration can offer a chance at a cancer-free future or significant symptom relief. Your surgical team will provide detailed information about the procedure, potential outcomes, and the necessary adjustments to daily life afterward.

Transanal Minimally Invasive Surgery, or TAMIS, is a way for surgeons to remove certain growths or early-stage cancers from the rectum through the anus without making any incisions on your abdomen. Think of it as a highly precise way to operate from the inside.

During a TAMIS procedure, the surgeon uses specialized instruments and a high-definition camera that are inserted through the anus. These tools allow the surgeon to see the area very clearly on a monitor and to precisely cut out the abnormal tissue. Because the surgery is done through the natural opening of the anus, there are no external cuts, which typically leads to less pain, faster recovery, and no visible scars on your belly.

TAMIS is often used for removing rectal polyps (small growths), early-stage rectal cancers, or other lesions that are located close to the anus. It's a less invasive option compared to traditional surgery, which might require larger incisions and a longer hospital stay.

The procedure is usually done under general anesthesia. After the surgery, you might experience some mild discomfort or bleeding, but most people can go home within a day or two. Your doctor will give you specific instructions for recovery. TAMIS offers a way to treat certain rectal conditions effectively with a gentler approach and a quicker return to your normal activities.

An in-office flexible sigmoidoscopy is a quick and relatively easy procedure that allows your doctor to look at the inside lining of the lower part of your large intestine, specifically the rectum and the sigmoid colon. Think of it like a peek inside using a long, thin, flexible tube with a small light and camera attached.

During the procedure, you'll likely lie on your side on an exam table. The doctor will gently insert the flexible sigmoidoscope into your anus and slowly advance it through your rectum and into your sigmoid colon. The camera transmits real-time images to a video screen, allowing the doctor to see the lining of these areas. This helps them identify any abnormalities, such as inflammation, polyps (small growths), ulcers, or other issues.

One of the benefits of an in-office flexible sigmoidoscopy is that it's typically done without the need for heavy sedation or anesthesia, unlike a full colonoscopy. This means you can usually return to your normal activities shortly after the procedure. You might experience some mild cramping, bloating, or the urge to have a bowel movement during the exam, but it's generally well-tolerated.

Before the procedure, you'll likely need to do a simple bowel preparation, usually involving one or two enemas at home, to clear out your lower colon. This ensures the doctor has a clear view. If the doctor sees anything unusual during the sigmoidoscopy, they may take small tissue samples (biopsies) for further examination under a microscope. The results of the sigmoidoscopy and any biopsies will help your doctor diagnose any problems and determine the best course of treatment for you. It's a valuable tool for screening for certain conditions and investigating lower bowel symptoms.