Mayo Clinic Performs Groundbreaking, Single-incision Surgery to Remove Young Woman's Large Intestine
Abstract
SCOTTSDALE, Ariz. — A 19-year-old Arizona woman is believed to be just the second patient in the U.S. to have her entire large intestine removed via a single-incision, minimally invasive surgery.
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| The surgery, performed at Mayo Clinic by Tonia Young-Fadok, M.D., Chair of the Division of Colon and Rectal Surgery, is formally known as a proctocolectomy and ileal J-pouch reconstruction. Not only is the entire large intestine (both the colon and the rectum) removed, but a new rectum, called a J-pouch, is constructed for the patient, using the end portion of the small intestine. The alternative to the J-pouch, generally far less preferred by patients, is a permanent ileostomy, or a bag on the abdominal wall to collect waste. This operation was recommended to the patient because of a diagnosis of familial adenomatous polyposis (FAP), a genetically based, hereditary disease that results in the development of hundreds of polyps, beginning when the patient is in his or her teens or 20s. The operation is recommended to prevent the risk of developing colon or rectal cancer in the future. Without surgical removal of the colon and rectum, the risk of developing colorectal cancer is 100 percent. In the standard open procedure, a long, midline incision is required to allow surgeons access to the interior of the abdomen. In the standard laparoscopic procedure, four or five small incisions are used to deploy the laparoscopic instruments and to remove the diseased colon and rectum. The single-incision surgery was performed via the planned site of the patient's temporary protective ileostomy, with no additional incisions being required. Although the single incision procedure is very new, and most experience to date has been performed for simple gallbladder surgery (and not complex colorectal surgery), it is believed that there may be potential for improved post-operative recovery. Dr. Young-Fadok's major goal in developing this approach is to ensure that this new technology is adopted in a safe fashion. "It is important that this technology is evaluated by an experienced team, in a prospective manner, so that patients do not suffer complications from enthusiastic surgeons adopting single-port procedures without sufficient experience," cautions Dr. Young-Fadok. "All members of the surgical team were highly experienced with laparoscopic procedures and all were instrumental in ensuring the success of this operation." |
