Clinical Review

Laparoscopic colorectal surgery

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d8029 (Published 29 December 2011) Cite this as: BMJ 2011;343:d8029
  1. Oliver M Jones, consultant colorectal surgeon,
  2. Ian Lindsey, consultant colorectal surgeon,
  3. Chris Cunningham, consultant colorectal surgeon
  1. 1Department of Colorectal Surgery, Surgery and Diagnostics, Churchill Hospital, Oxford OX3 7LJ, UK
  1. Correspondence to: O M Jones oliver.jones{at}ouh.nhs.uk

Summary points

  • Laparoscopic surgery has been established as safe in colorectal surgery

  • Surgeons and hospitals need appropriate training and mentoring before adopting this approach

  • Offer patients a laparoscopic alternative to open surgery

  • Laparoscopic surgery remains technically challenging in conditions such as rectal cancer and will be inappropriate for some patients

  • The role of advanced technologies—including single port surgery, natural orifice surgery, and robotics—remains unclear

The uptake of laparoscopic colorectal surgery is increasing annually. Colon resection using this approach was first reported in 1991, but hospital episode statistics (HES) data show that 22% of colon resections in the United Kingdom in were performed in this manner by 2008-9.1 2 The laparoscopic approach minimises surgical trauma and allows faster recovery from surgery, and it has been evaluated for other operations, such as cholecystectomy. Early reports of the outcomes of laparoscopic colorectal surgery comprised mostly non-malignant cases, but more recently laparoscopic surgery has become widely used for colorectal cancer. Updated guidance (2010) from the UK National Institute for Health and Clinical Excellence recommends that all patients deemed suitable must be offered laparoscopic surgery even if this means onward referral to a suitably qualified surgeon.3 We review the effectiveness of laparoscopic colorectal surgery compared with open surgery and the potential adverse effects.

Sources and selection criteria

We searched the Cochrane databases using the terms laparoscopic, colorectal surgery, colorectal cancer, diverticular disease, Crohn’s disease, and ulcerative colitis to identify observational studies, case series, and randomised trials.

What are the benefits of laparoscopic colorectal surgery?

The rationale for using laparoscopic surgery is that it can help minimise the trauma of access, reduce pain, and accelerate postoperative return of bowel function and general mobility. All these factors may shorten hospital stay. Other potential benefits include reduced formation of adhesions and lower rates of incisional hernia.

A trocar, which acts as a conduit for the camera and operating instruments, is …

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