What is a laparoscopic total abdominal colectomy?
A laparoscopic total abdominal colectomy is an operation that removes the large
intestine. (See figure 1) The surgery is used to treat:
- Inflammatory conditions of the intestine, such as Crohn's disease and
ulcerative colitis
- Familial polyposis, an inherited (hereditary) condition in which
hundreds to thousands of polyps (small growths) form throughout the entire
length of the large intestine Severe, chronic constipation
(Fig
1 to right: Total abdominal colectomy removes all of the large intestine
(area shaded in diagonal lines).
The term "laparoscopic" refers to a type of surgery called
laparoscopy. Laparoscopy enables the surgeon to complete the surgery through
very small "keyhole" incisions in the abdomen. A laparoscope, a small,
telescope-like instrument, is placed through a small incision near the navel.
What happens during the surgery?
There are three main steps to this surgery.
Step 1: Positioning the laparoscope
Once you are under anesthesia, the surgeon will make a small cut (about
1/2 inch) near the navel. A laparoscope will be inserted into the abdomen
through this incision. Images taken by the laparoscope will be projected onto
video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make 3- 5
more "keyhole" incisions in the abdomen (see figure 2). The number and position
of these incisions depend upon the build of the patient, surgeon preference and
difficulty of the operation. Surgical instruments will be placed through these
incisions to complete the surgery.
(Fig 2 to right: Laparoscopic surgery is
performed through 4 or 5 small incisions in the abdomen).
Step 2: Dividing the sigmoid colon and rectum
The colon is a large organ (about 5 feet long) that starts at the end of
the small intestine (ileum) and ends at the rectum. The last section of the
large intestine, called the sigmoid colon, joins with the rectum. (See figure
1.) Your surgeon will carefully free the colon in sections, these include the
rectum and sigmoid colon, the descending (left) colon and the ascending (right)
colon. The surgeon will also free the "splenic flexure," a bend in the colon
that lies just below the spleen and the "hepatic flexure," the corresponding
bend that lies under the liver. Throughout the procedure, the surgeon will use a
paddle-like instrument to hold loops of the intestine up and out of the way. The
main blood vessels (arteries) that supply blood to the colon will be carefully
tied and divided throughout the surgery.