A laparoscopic total abdominal colectomy is an operation that removes the large intestine. This is used to treat conditions including:
Inflammatory conditions of the intestine, such as Crohn's disease and ulcerative colitis
Familial polyposis, an inherited (hereditary) condition in which hundreds to thousands of polyps (small growths) form throughout the entire length of the large intestine
The term "laparoscopic" refers to a type of surgery called laparoscopy, which allows the surgeon to complete the operation through very small (5-10 mm) incisions in the abdomen. A laparoscope, a small telescope-like instrument, is placed through a small incision near the navel.
The World Health Organization (WHO) classification of tumors of the colon and rectum include the following:
Intraepithelial neoplasia (dysplasia) associated with chronic inflammatory diseases
Low-grade glandular intraepithelial neoplasia.
High-grade glandular intraepithelial neoplasia.
The Three Steps of Laparascopic Total Abdominal Colectomy
Step 1: Positioning the Laparoscope
Once you are under anesthesia, the surgeon will make a small cut (about ½ inch) near the navel. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make four or five more small (5-10 mm) incisions in the abdomen. Surgical instruments will be placed through these incisions.
Step 2: Dividing the Sigmoid Colon and Rectum
The colon is a large organ (about 5 feet long) stretching from the small intestine (ileum) to the rectum. Doctors divide the colon into four main sections, ascending (right), transverse, descending (left), and the sigmoid colon, which attaches to the rectum. Your surgeon will carefully free the colon in sections, starting with the rectum and sigmoid colon, and finishing with the ascending (right) colon. The main blood vessels (arteries) that supply blood to the colon will be carefully cut and closed throughout the surgery.
Throughout the procedure, the surgeon will use a paddle-like instrument to hold loops of the intestine up and out of the way. When the entire large intestine is freed, the surgeon will free the right colon from the ileum and then identify the part of the ileum that will be rejoined with the rectum.
Finally, your surgeon will pass a snare-like instrument over the colon to make sure that all of the attachments to the tissue have been cut. This snare-like instrument is designed to hold a wire loop, which is tightened by the surgeon around any remaining tissue growths to remove them. Once this is complete, he or she will enlarge one of the incision sites and pull the colon out of the abdominal cavity.
Step 3: Rejoining the Ileum and Rectum
Next, your surgeon will rejoin the rectum and ileum. This rejoining is called an "anastomosis." A circular stapler with an anvil-shaped head and center post and rod will be used to make the anastomosis. First, the anvil-shaped end of the stapler (the end with the post) is passed into the ileum and stitched into place. The post will extend beyond the cut end of the ileum. To complete the anastomosis, the rod of the circular stapler is passed into the rectum, connected with the center post, then closed and "fired" to join the ileum with the rectum. This is called an ileorectal anastomosis (IRA). As an alternative to the IRA, some patients may require the creation of a reservoir from the small intestine. This reservoir is called an ileal pouch anal anastomosis (IPAA).
The surgeon will then rinse the abdominal cavity and check the anastomosis for leaks. Finally, all of the incisions in the abdomen will be stitched or taped closed.