Single Incision Total Colectomy Operation

A 32-year-old woman from Maricopa, Ariz., who was at risk for colon cancer, is believed to be the first patient in the U.S. to undergo single-incision total colectomy "an operation in which in the entire colon is removed.

Single-incision surgery is unique in that a single, small, three-centimeter incision is made around the navel to allow instruments to be placed within to extract the colon. In this case, it was the only incision made for what was a complex surgery in which the right colon, transverse colon, descending and sigmoid colon were removed, and the patient's small bowel was joined directly to the rectum.

In traditional laparoscopic colectomy, four or five small incisions are required to perform the operation and remove the colon.

The landmark surgery was performed by Tonia Young-Fadok, M.D., Chair of the Division of Colon and Rectal Surgery at Mayo Clinic, who explained that the patient has a condition known as attenuated familial adenomatous polyposis "a condition in which the colon develops multiple polyps that will progress to cancer if the colon is not removed.

As explained by Dr. Young-Fadok, once the incision is made around the navel, a multi-port trocar (a medical device used to insert laparoscopic instruments) was placed. A small camera and instruments were then introduced into the incision via the trocar to mobilize the colon from its attachments and remove the specimen from the abdominal cavity.

In the case of this first patient, removal of her entire colon significantly reduces her risk of colon cancer.

The operative time for the single-port surgery was similar to that of standard laparoscopic total colectomy, according to Dr. Young-Fadok, and the patient was able to be discharged three days following surgery.

"Single-incision surgery is one of the next steps in the continued development of minimally invasive surgery," said Dr. Young-Fadok. "Further studies will be necessary, but there may be advantages for the patient. Certainly the procedure maintained the advantages of laparoscopic surgery over open surgery with a rapid post-operative recovery, and there may be additional benefit from having one small incision rather than multiple small incisions.

In May, Mayo Clinic in Arizona also performed its first single-incision gallbladder removal.

Reference: Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. As a leading academic medical center in the Southwest, Mayo Clinic focuses on providing specialty and surgical care in more than 65 disciplines at its outpatient facility in north Scottsdale and at Mayo Clinic Hospital. The 244-licensed bed hospital is located at 56th Street and Mayo Boulevard (north of Bell Road) in northeast Phoenix, and provides inpatient care to support the medical and surgical specialties of the clinic, which is located at 134th Street and Shea Boulevard in Scottsdale.