Innovative Approaches to Colorectal Surgery Benefit Patients

Published in Surgery - Surgery Winter 2019

The field of minimally invasive surgery as it relates to colon and rectal disease has seen many advances since it was first introduced in the 1980s. To that end, experts within the Johns Hopkins Division of Colon and Rectal Surgery have become some of the first to adopt several new minimally invasive approaches to treat benign and malignant colorectal conditions.

These complex techniques, which require extensive surgical training and skill, offer patients significant benefits including less pain, less blood loss, better cosmetic outcomes and quicker recoveries. “We are committed to doing what’s best for our patients,” says Bashar Safar, the new division chief of colorectal surgery in the Johns Hopkins Department of Surgery, “whether it’s at The Johns Hopkins Hospital in downtown Baltimore or in Washington, D.C., at Sibley Memorial Hospital or Suburban Hospital.” 

Combined ESD and TAMIS Among the First in the U.S. 

In 2017, Johns Hopkins physicians were among the first in the U.S. to perform a combined endoscopic submucosal dissection (ESD) and transanal minimally invasive surgery (TAMIS) to remove a large rectal polyp. 

The first combined ESD-TAMIS procedure at The Johns Hopkins Hospital was performed by gastroenterologist Saowanee Ngamruengphong and colorectal surgeon Sandy Fang. A month post-surgery, the patient was eating and having regular bowel movements. Since then, the duo has completed three more ESD-TAMIS surgeries on patients who otherwise would have had their rectum removed.  

“Together with TAMIS, ESD can remove the entire lesion in one piece and the risk of recurrence becomes less than 1 percent,” says Ngamruengphong.

In addition to being minimally invasive and having good functional outcomes, the multidisciplinary team approach of ESD-TAMIS allows for an easier recovery and a shorter stay in the hospital. Ngamruengphong says the best candidates are patients with large noncancerous rectal polyps or those with early stage rectal cancers who are not healthy enough to undergo a large operation.

“Lesions in the rectum can be treated in many different ways,” says Fang. “One doctor might provide limited options, but a whole team that evaluates the patient can provide more options and potentially better outcomes.” 

Additional Minimally Invasive Options for Benign and Malignant Colorectal Disease

Laparoscopy can be applied to nearly any disease treated by surgery, including diverticulitis, rectal cancer, Crohn’s disease and pelvic floor disorders such as rectal prolapse, according to Alodia Gabre-Kidan, a colorectal surgeon at Howard County General Hospital, a member of Johns Hopkins Medicine. 

For example, a total colectomy for patients with severe ulcerative colitis can be an intricate surgery because “we need to access everywhere that the colon lives in the abdomen,” says Gabre-Kidan. “You may think you need a big open incision because the disease process is so complicated, but many times, we can offer a minimally invasive approach. We’re committed to doing anything we can to help make postoperative outcomes better, and advanced laparoscopy is one of those things.” 

Another option for minimally invasive surgery includes robotic colorectal surgery. Providing patients with new options when treating complex conditions, such as rectal cancer, is one of the most rewarding aspects of Haniee Chung’s job as a colorectal surgeon at Sibley Memorial Hospital and Suburban Hospital, both members of Johns Hopkins Medicine in the greater Washington, D.C., area. Chung also performs ESD-TAMIS at these hospitals. 

“Cancer itself is a devastating diagnosis that changes a patient’s life, and on top of that, patients are often told that they’ll need a big operation that will alter their lifestyle and function,” she says. “We push the limits so we can offer patients quicker recoveries and better functional outcomes.”

To discuss a patient case or to make a referral for minimally invasive surgery, call 443-997-1508. View a case presentation of the first-ever ESD-TAMIS procedure.