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Treating colorectal cancer through single-site laparoscopy – Penn State Hershey Cancer Institute David Stewart, MD, a board-certified colorectal surgeon at Penn State Hershey Cancer Institute, Penn State Milton S. Hershey Medical Center, talks about a recent advance in surgery called single-site laparoscopy, a technique used to treat colorectal disease, including the removal of colon and rectal cancers through a single skin incision.

So, just as in other forms of colon and rectal surgery there’s been a gradual and progressive development of techniques that are less invasive, techniques that allow us to accomplish the same set of goals that we had when were performing surgery through large incisions, but to achieve those same goals through small incisions.

And over the last 10 to 15 years, what we’ve seen is a progression through incisions that are getting smaller and smaller and fewer and fewer.
And more recently this has culminated in the development of single site laparoscopy or SSL for short.

And what this involves is making a single incision anywhere on the abdominal wall, and very often the site that’s chosen is the belly button.

The belly button is a nice location for a single incision laparoscopic approach, because it’s the thinnest portion of the abdominal wall and the belly button for most patients is concave and so it hides a scar very well.

We place our camera and two other working instruments through that incision and we can perform the same operation and achieve the same goals that we were achieving through multiple small incisions with the advantage that we now just have one incision.

Well, ideally we would like to make every patient a candidate for the procedure because we believe that there are advantages for patients who have their surgery performed laparoscopically as opposed to– through a larger incision or through open surgery.

And some of those advantages would be that patients are usually able to leave the hospital in two to three days.

They have very minimal postoperative pain. Some of our patients don’t even require prescription pain medication or narcotics for pain control.

Some do, but those that do usually aren’t requiring weeks and weeks of pain medication.

It’s usually several days to a week of intermittent pain medication.

People are able to eat the evening of surgery. They’re able to walk beginning the evening of surgery.

There’s some discomfort, but it’s quite minimal because the incision is so small. In our practice, you know because we have experience with single site laparoscopy.

We’ve been you know performing it regularly for over a year.

In our practice if you have a body mass index of less than 50, if you’re stable, meaning it’s not an emergency surgery where you’re having to perform heroic measures to keep your heart beating and your blood circulating and if you’ve had fewer than three previous open surgeries, then you’re a candidate for single site laparoscopy.

And in the vast majority of those cases you know we’re able to achieve a safe surgical outcome and to use this minimally invasive technique.

The first reported SSL or single site laparoscopic surgery was actually the removal of a gall bladder at a different institution in 1997.

And SSL is relatively new to colon and rectal surgery.

It’s really only been reported for the last three to four years, but it is new and it’s not used at very many centers and so we’re, you know we’re proud of what we’ve been able to accomplish here in terms of you know making this available for our patients because we do believe that it offers some advantages.

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