Laparoscopic or “keyhole” surgery is a technique applied to branches of surgery. The first operation widely performed in General Surgery was removal of the gall bladder. The techniques of laparoscopic surgery have been developed to enable complex bowel surgery to be performed by these methods. Studies of the effectiveness of keyhole techniques in diseases of the colon and rectum have shown that laparoscopic surgery can achieve similar results in terms of patient survival and cure as the traditional open operations.

In colorectal operations the keyhole method involves passing a camera and surgical instruments through a number of ports in the abdominal wall (images 1 and 2). The incisions used for the ports are small measuring about 10-12mm. Completing the operation will usually involve making a slightly longer incision at the site of one of the initial small incisions so as to deliver the diseased bowel. It is this process of the so-called minimal access technique which gives benefit to the patient.

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Examples of advantages to the patient are:
1. Faster recovery and return to normal activity
2. Shorter hospital stay
3. Reduced post-operative pain due to smaller incisions
4. Cosmetically better results from smaller scars
5. Early mobility and consequent reduction in deep vein thrombosis
6. Reduced long-term complications from adhesions in the abdomen

The keyhole method can be widely applied in colorectal surgery. The following are diseases that can be treated by laparoscopic surgery:
1. Bowel cancer either colon or rectum
2. Diverticular disease
3. Inflammatory bowel disesase either Crohn`s or ulcerative colitis
4. Rectal prolapse

Not all patients will necessarily be suitable for laparoscopic surgery either due to the disease itself or occasionally due to other medical problems the patient might have. It is also not always possible to complete an operation laparoscopically. If it was evident at the time of surgery that the keyhole method could not be completed then the operation would be converted the traditional open technique. All patients undergoing keyhole surgery understand that the operation might have to be converted and agree to that possibility beforehand.

Mr Reay-Jones has attended training courses both in France and the United Kingdom to gain the skills required to perform these laparoscopic procedures. His practical training has been under the Laparoscopic Preceptorship programme run by the Association of Coloproctology of Great Britain and Ireland to ensure competency in these procedures.


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