December 31, 2010
Dear Mayo Clinic:
I've heard that Mayo Clinic is one of the only places that does natural orifice surgery. Do you do it for colon cancer surgery, and how does it work?
Mayo Clinic is one of a few institutions that perform natural orifice surgery. A spectrum of operations may fall under the definition of natural orifice surgery, and a variety of descriptions are found in the medical literature. Using a natural orifice to assist in a surgical procedure is done when the surgeon is trying to minimize or eliminate the need for abdominal wall incisions. Natural orifice surgery can range from specimen extraction, to small abdominal incisions, to an entire operation that is done through natural orifices with no abdominal wall incisions.
The body's own natural orifices, or openings, that can be used for this type of surgery are the mouth, rectum or vagina.
In the last several years, surgical specialties — including general, cardiac, colon and rectal and gynecological surgery — have shifted significantly toward using less invasive techniques to treat patients. These techniques, such as laparoscopic and robotic-assisted surgeries, minimize or reduce incisions and the trauma of open surgery.
Minimally invasive procedures can mean less risk of infection, less pain and quicker healing with less scarring. And one option for a minimally invasive procedure is to use the patient's natural orifices to access, diagnose and treat different parts of the body.
For colon cancer surgery, we have used a natural orifice approach in which the operation is done laparoscopically or robotically to access the abdominal cavity, and then the colon, the tumor and all lymph nodes are extracted through a natural orifice such as the rectum, vagina or anus. In this way, a formal abdominal wall incision is avoided. This minimizes the risk of wound infections, hernias and significant postoperative pain.
A completely natural orifice surgery for colon cancer patients, in which no abdominal wall incisions are made, is not currently being done at Mayo Clinic. Reports in medical literature on these approaches have been limited to cadavers and animal studies.
Some patients may not be candidates for minimally invasive approaches such as natural orifice surgery. For example, if someone has a very large tumor that needs to be removed, the natural orifice approach would not be safe or appropriate. Also, some prior surgeries may reduce the likelihood of these options.
Natural orifice surgery has been demonstrated to be safe and effective in specific diagnostic and treatment procedures. The field will expand as we continue to devise smaller, automated tools and new surgical techniques. In any case, the decision to use it should be based solely on the benefits and risks to the patient and the patient's preference.
If you have questions about minimally invasive procedures such as natural orifice surgery, take them to your care providers for further discussion. Consider carefully the surgeon's experience, the risks involved — especially when compared to a traditional surgical approach — and your needs. You should feel well informed about your choices.
— Eric Dozois, M.D., Colon and Rectal Surgery, Mayo Clinic, Rochester, Minn.