Scarless Surgery? (Video)

3d image of colon

When laparoscopy was new in the 1990s, many colorectal surgeons thought it was a bad idea. It was never going to apply to colon surgery. This minimally invasive technique was good for gallbladder surgery, but for colon surgery, we thought it was not worth the time or the effort. The surgery was difficult to perform and the surgical tools were primitive.

Even when I was in my training as short as five years ago, the common way to remove the colon was at least through a 10-inch incision, which could be up to a 15-inch incision depending on the size of the patient.

However, as surgeons’ laparoscopic skills improved over time, it became clear that a minimally invasive technique such as laparoscopy could tackle more than a gallbladder or an appendix. Incisions got smaller, operating room times dropped and instruments got better. Surgeons started doing laparoscopic colon removal surgery until it became commonplace.

Warning: The video is graphic. Viewer discretion is advised.

This traditional laparoscopy leaves four to six incisions in the person’s abdomen. A special rod connected to a video camera is inserted through a small incision in the person’s abdomen. Then, three to five additional small incisions are made and used as “ports” in which to insert instruments to remove the colon.

But we could do better. As this method proved successful, colon removal with one single incision, called “single-port proctocolectomy,” became a game changer for patients. During the procedure, first performed at Cleveland Clinic, a special port is placed over the patient’s belly button, allowing for attachment to a camera and instruments for removing the colon all through one incision. We remove a person’s entire large intestine and rectum (which make up the colon) and leave only one coin-sized scar hidden in a person’s belly button.

One of the unique facets of colon surgery, which is not true of every specialty, is that the surgeon must remove the colon intact. This means that we always need a 2- to 3-cm incision to get the colon out. Three centimeters is plenty of room to put two instruments and a camera and remove a colon with no added incisions. The goal is to make the hole exactly big enough to get the colon out.

With this single-incision technique, I remove one to two colons weekly, using patients’ ileostomy sites for the incision. It’s an amazing procedure, just getting rid of the colon, getting rid of what is making people sick turns them around very quickly. With this technique, we help patients with colon cancer, Crohn’s disease, ulcerative colitis, diverticulitis or constipation when doctors advise that the colon be surgically removed.

Potential benefits of single-port proctocolectomy include minimal or no scarring, shorter hospital stays, faster recovery and reduced pain for patients. This procedure has been thought to possibly improve female fertility after surgery by minimizing scar tissue in the abdomen.

Particularly for young people, I think there’s a real benefit to not having incisions all over your abdomen cosmetically. While we still need randomized studies to prove a benefit, surgeons who are good at it are doing so because they believe that the results are at least equal to laparoscopy. I think it’s the future of colon and rectal surgery as we keep moving forward.

The instrumentation is becoming so advanced that we may see a day when surgeons are able to operate inside the colon and rectum, which would mean no incisions for patients. I welcome this innovation and look forward to the day when even single-port surgery is considered too invasive because of new, better techniques.

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Meagan Costedio, MD

Meagan Costedio, MD, is a surgeon in the Department of Colorectal Surgery whose interests include minimally invasive techniques.
  • c lees

    I’ve had 2 rectal fissures removed a few years apart and in different areas of rectum. Should I be worried.

  • Annie J

    I think this is one of the best articles I have ever read concerning this subject. One thing you didn’t address though, is medication as a cause of constipation. No amount of Metamucil has helped in that regard. This is medication that I have to take, so what advice is there for that situation?

  • Dianne jones

    I had silent bleeding. I was feeling awful for about a year. I went to donate blood. They tested me. My HGb was 5.5. I saw my MD. Had fissures in colon. Surgery stopped the bleed

  • weez

    I was taking low dose aspirin to lower colesterol It caused rectal Bleeding! I passed out in the bathtub, ended up
    In the Hospital.. I stopped the aspirin and the bleeding stopped!

    • http://war-on-fines.blogspot.com/ Abdominal Pain

      Bleeding from WHERE? I blamed low-dose aspirin for bleeding which was actually coming from a POLYP, which could have been removed before it turned cancerous, but wasn’t. I too stopped the aspirin and the bleeding stopped. Then it started again…

      (Re-posted without the link.)

  • Bibi

    Metamucil is full of artificial ingredients. Organic Psyllium husks are much healthier.

  • Ghyail Williams

    I now use metamucil, very happy with the results.

  • Karen Jones

    A good friend of mine is bleeding from somewhere indide and the Doctor’s cant find out where.He has had all the test done twice are more and still they cant seem to find where its comming from.Please what could this be?

  • Emily

    I have a what seems like a hemorrhoid and it itches, but I don’t use the flushable wipes, do you know what it could be and why it itches ?

  • Echo

    I had a terrible experience with diverticulosis and ended up in the ER for 4 hours and finally the pain subsided and I went home with no further treatment. They hadn’t seen me in four hours but then suddenly said I shouldn’t leave because it could have been kidney stones. Three days later I was scheduled for an MRI to determine if I had diverticulosis — and I do !!! I had been eating lots of nuts and seeds prior to the onset of the severe pain. I don’t eat them now and the pain is GONE! Occasionally, I believe I feel a “soft” pain probably from “gas” if I eat too many cruciferous veggies such as broccoli or cauliflower. My BEST remedy for the pain is a heating pad applied to the painful area — most articles say it’s on the LEFT side — mine is on the right — and I drink a double-strength cup of hot chamomile tea which also works 100% of the time when you have trapped gas. It works generally in 20 minutes.
    Maybe this all sounds crazy to you, but I learned of the chamomile trick years ago from an older woman in my office. I tried it and swear by it. Awesome.
    Also, I STILL believe in staying away from the nuts, seeds, popcorn, corn, etc. that in the past they said irritated the pockets in the colon. The pain it caused me that put me in the ER that day is not worth eating stuff like that again. I miss them, but I’m not a glutton for pain either. One or the other. Best wishes.

    • terryparker

      i also just found my right side was in so much pain and it felt like the first hard labor pains . i woke up to this i believe my was brought on by strawberries and hornoll less popcorn. ty you for sharing i am trying to ;learn much more about this condition.

      • Echo

        And thank you for verifying that it CAN be on the RIGHT side. My doctor and all the accounts I’ve read have indicated on the LEFT side. On the other hand, the doctor said it is rare on the right side. Leave it to me (and now you!!!) to be different!!! I don’t mind being different, but when it strikes, it’s vicious. I’m sure I don’t have to tell you — labor pains is right. Just unbelievable. The thing that’s amazing to me is that it stops you in your tracks from eating things that are supposed to be good for you — nuts, seeds, and some fruits because of their seeds. Don’t forget, tomatoes, cucumbers, zucchini and squash, too! And DEFINITELY NO CORN OR POPCORN!!! You will die a slow death if you eat them — or you’ll think you’re dying . . . I’m sorry we share the same malady. Do take care and watch other things like salad dressings with seeds, etc.
        A LOT of label/ingredient reading . . . ;(

      • Echo

        One more thing — actually a couple more things — don’t overdo on the cruciferous veggies such as cauliflower and broccoli and perhaps spinach — anything that may cause gas. Fiber is good for you, but watch that, too, as it may cause gas if eaten in large amounts. BUT, if you should get those awful pains — and this is for EVERYONE — keep CHAMOMILE TEA on hand AT ALL TIMES . . . Many years ago an older woman told me about it and how it relieves that “bloated feeling”. Just brew up a cup, let it steep about 6 minutes and drink as much as you can while it’s still hot. Give it about 10-15 minutes to work. You may have to go to the bathroom, burp or pass gas, but it won’t last long but the results are worth it. Not a savory subject to discuss, but saves hours of pain.