Key-Hole (Laparoscopic) Bowel Surgery

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Key-Hole surgery has the benefit of reduced size of incision, leading to better cosmesis and reduced pain. This allows for earlier mobilisation with less, pain, and earlier resumption of normal activities including earlier return to work.

Figure 1. Key-hole surgery with small incisions for camera and instrument insertion, thereby avoiding a large incision

Key hole (laparoscopic) surgery has now been shown in multiple randomised controlled trials to be safe for colon cancer surgery. A large number of randomised controlled trials [1-8] and a large review[9], have shown similar benefits for rectal cancer surgery. Two large Australian studies have shown its safety for colorectal cancer with benefits in both young and elderly patients [10-11].

Robotic surgery is an emerging technology that combines the benefits of minimally invasive surgery with the fine-motor precision afforded only by robotics. It’s most useful application is for surgery low in the pelvis, making it particularly suitable for low rectal cancer surgery. It provides many of the benefits of laparoscopic surgery, with its improved control allowing for better resection margins and less blood loss.

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References
1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718-1726.
2. Araujo SE, da Silva eSousa AH Jr, dr Campos FG, et al. Conventional approach laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sau Paulo. 2003;58:133-40.
3. Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 2008;15:2418-2425.
4. Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004;363:1187-1192.
5. Kang S et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010;11:637-645.
6. Zhou Z, Hu M, Li Y, et al. Laparoscopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 2004;18:1211-1215.
7. Braga M, Frasson M, Vignali A, et al. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 2007;50:464-471.
8. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 2009;96:982-989.
9. Breukink S, Pierie J-P, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005200. DOI: 10.1002/14651858.CD005200.pub2.
10. Allardyce RA, Bagshaw PF, Frampton CM, et al. The Australasian laparaoscopic colon cancer study. ANZ J Surg. 2008;78:832–833. 
11. McKay GD, Morgan MJ, Wong SKC, et al. Improved Short-term Outcomes of Laparoscopic versus Open Resection for Colon and Rectal Cancer in an Area Health Service: A Multicentre Study. Diseases of the Colon & Rectum 2012: 55(1); page 42-50.