Laparoscopic Surgery
with Joel Turner, MD
Which region of the world has the highest rate of skin cancer?
Laparoscopic surgery is just one type of minimally invasive cancer treatment performed at GBMC and throughout the world. According to Joel Turner, MD, Chief of Minimally Invasive Surgery at GBMC, the term laparoscopic refers specifically to surgeries within the abdomen and pelvis. “Most laparoscopic cancer surgery cases are related to colorectal or prostate cancer. Laparoscopy is also used to treat renal cell cancer, which is kidney cancer,” he says.
Most often, laparoscopic surgery is used as a first line of cancer treatment. “Usually, we use laparoscopy to remove cancer that is contained, meaning it has not spread past the organ where it originated,” says Dr. Turner. Cancers that have spread to the lymph nodes or other organs are often treated through traditional surgery, radiation, chemotherapy or a combination.
At GBMC, cancer treatment plans for colorectal, prostate and kidney cancer are often developed at a weekly tumor conference. “The multidisciplinary tumor conference is a unique opportunity to present difficult operative and postoperative issues to surgeons, radiologists, radiation oncologists and other cancer experts. We can even make referrals to other professionals right then and there,” says Dr. Turner.
Along with good treatment results, laparoscopy provides benefits for patients. “Generally, laparoscopic patients have less need for pain medication, have a shorter hospital stay and return to work more quickly,” says Dr. Turner. “There are also fewer postoperative complications such as hernia or infection at the surgery site.”
A laparoscope, which is the tool used in laparoscopy, is a rod and lens system that is inserted into the surgical site through small incisions. In fact, most incisions range from five to 12 millimeters in length, with the exception of procedures that require the removal of an entire organ. Even then, the cut is usually only five centimeters long.
For cancers that require organ removal, Dr. Turner says “Many surgeons use soft hand ports for a combined laparoscopic hand-assisted approach. It provides better control and results in shorter operative times.” Hand-assisted laparoscopic surgery allows a surgeon to insert a hand into the body through a small incision and a pressurized sleeve. The surgeon has a better sense of touch and depth and is able to use one hand along with the surgical instruments to remove the organ. Like all laparoscopic procedures, the entire surgery is done while viewing the inside of the body on a television monitor.
The laparoscope allows magnification of the image by a high definition camera. “The support staff can clearly see exactly what the surgeon sees during the procedure,” says Dr. Turner. The number of staff present for a laparoscopy is the same as for open surgery, and includes an anesthesiologist, scrub tech, assistant surgeon and other surgical support.
Although laparoscopes are currently somewhat rigid, in the future, they may be more flexible. “Right now, we spin the scope to look around corners. New technology is being developed to allow the tip of the laparoscope to move like the tip of an endoscope,” says Dr. Turner. An endoscope is a flexible scope commonly used to detect diseases in the colon and the rest of the digestive tract.
Other laparoscopic improvements include infrared technology to enhance visibility and smaller cameras with better lighting to further advance video quality.
