Scarless op to take out colon cancer via your belly button

KEYHOLE COLON CANCER SURGERY

COLON cancer is one of the most common cancers in the UK and rates are rising. Julia Lonsdale, 65, a retired nurse, underwent a new procedure to remove her tumour, leaving no visible scar, as she tells REBECCA WALLERSTEINER.

THE PATIENT

THREE years ago, just after my 62nd birthday, I was sent a self-diagnosis NHS bowel cancer testing kit through the post. The test requires sending a small stool sample to a lab to check for traces of blood. I used to work as a nurse at St Mary’s Hospital, in London, which specialises in cancer surgery, so I knew how important this test is and didn’t hesitate to send mine back.

Even so, it was still a huge shock when, three weeks later, I was called in for a colonoscopy, where they look at the bowel with a sort of telescope. This revealed a very small cancerous growth, about ½ cm wide, in my colon (the lower section of the bowel).

until then I’d thought I was fit and healthy — I swam three times a week and felt fine. What’s more I’d experienced none of the usual symptoms, such as a change in bowel habits or bleeding from the bottom.

When I saw the surgeon who was going to remove the growth, Barry Paraskeva, he told me about a new technique for doing this. Traditional keyhole procedure involves four small incisions — and four scars.

But Mr Paraskeva explained that he could remove the growth by going through a single tiny incision in my belly button, meaning there would be no visible scars, less pain, less chance of infection and hopefully a faster recovery.

Mr Paraskeva said that we had caught the cancer early and it was likely that my outcome would be very good and I wouldn’t need any further treatment such as chemotherapy. I was to be the first person to have this type of surgery for colon cancer, but I had complete confidence in Mr Paraskeva. The operation was performed in May 2012, a month after I was diagnosed, under a general anaesthetic. The procedure took an hour-and-a-half. When I came round, I was tender around the belly button.

I was surprised when Mr Paraskeva told me that he’d not only removed the cancerous growth but also more than a foot of my colon to ensure that all the cancer cells in surrounding tissue had been removed — all through the tiny cut in my belly button.

Three days later I went home, with only a small dressing over my belly button. I had to take painkillers for a day, or two. Even after a week, it was difficult to see the scar. Losing the section of my bowel hasn’t caused any problems. A few months later I was swimming a couple of times a week.

I still have to have a colonoscopy every year. Three years on, I feel wonderful and am very grateful to Mr Paraskeva and his team.

If you get an NHS colon cancer testing kit in the post, don’t disregard it — if it hadn’t been for the test I wouldn’t have realised that something was wrong as I had no symptoms.

It is likely that I would have seen my doctor at a much later stage, when the cancer could have spread to my liver and lungs. Even if you feel healthy, the screening test could save your life.

THE SURGEON

Barry Paraskeva is a consultant colorectal surgeon at st Mary’s Hospital, Imperial College Healthcare NHs Trust, London. Julia was my pioneer patient for removing bowel cancer through the belly button. She had an early cancer in the form of a cancerous polyp — a small growth on the lining of the bowel.

Not all polyps are cancerous — though they may turn into cancer eventually. Often benign polyps or early cancers can be cut away wh e n they are discovered during a colonoscopy.

However, for some people surgery is required to make sure no cancer cells remain. Since early 2008 I have been developing an almost scarless technique, known as single incision laparoscopic surgery (SILS), using a single incision through the belly button for various forms of abdominal surgery, such as gallbladder removal.

The traditional keyhole operation requires three or four incisions over the part of the colon where the cancer is located, which can be at different areas on the abdomen, and involves a hospital stay of seven to ten days.

By comparison, SILS involves a stay of three to four days and SILS patients are usually back to their normal activities in two weeks, as opposed to six to eight weeks for the traditional surgery. One incision means less damage to the body, so healing time is reduced.

The single scar is hidden in the belly button, which makes patients happy and helps them maintain a positive body image.

SILS is also a good option for overweight people because there is less fat around the belly button, so it is easier to access the part of the body you need to operate on. It is also useful for people prone to lumpy, raised scars — known as keloid scarring.

The belly button is a preexisting scar on the body (from where the umbilical cord used to be attached), so it is easier to open this up and remove organs this way rather than make new incisions. It provides a natural crease, which means scars remain buried — it doesn’t matter if you have an ‘innie’ or an ‘outie’.

To remove colon cancers, we make a 2 cm cut in the belly button, and open it up slightly outwards. We can then insert the surgical instruments, along with a camera so everything we do can be seen on a screen.

Although Julia’s cancer was small, we still needed to remove a section of her colon.

To do this, we use a tiny blade, which also has an electric current running through it; this generates heat to enable us to seal the blood vessels as we cut and prevent bleeding. Once detached, the section of colon is pulled out through the belly button in one piece — it was about 20 to 30cm long in Julia’s case. I then re-attached the two sides of her colon internally.

Before closing up, I put the camera back in to inspect the surgery site to make sure that all the necessary tissue is removed and there is no bleeding.

The belly button is then stitched up and pushed back into place.

Many SILS operations are performed as day cases — and generally, patients can return to work in a week. The results of Julia’s surgery are excellent and she has been left with no visible scar.

This procedure can also be used for non-cancer bowel conditions, including ulcerative colitis, an inflammatory bowel condition that can sometimes require surgery to remove diseased sections of the large intestine.

Going in through the belly button is not suitable for everyone — in about 15 per cent of patients it is not possible, or is unsafe. For instance, an abdomen that has been operated on many times might not be suitable due to scar tissue, which is more likely to rupture. These patients would require open surgery.

The technique can be more fiddly than the traditional surgery, and it helps if a surgeon is ambidextrous (where someone is neither right or left handed, and both hands are equally capable) which I am — though it is possible to develop this ability.

The risks are the same for the standard keyhole colon cancer surgery, including infection and bleeding.

This is a safe and effective technique and I would like people to be aware that it’s available on the NHS at some centres around the UK.

ANY DRAWBACKS?

MARK COLEMAN, consultant general and colorectal surgeon, at Plymouth Hospitals NHS Trust, says: ‘ Single incision laparoscopic surgery is still an uncommon procedure for bowel cancer. It’s not associated with any particular additional complications and is thought to be cosmetically better.

‘However, early evidence shows that this type of procedure is more difficult for a surgeon to learn compared with standard keyhole surgery and does not carry significant clinical benefits. It also requires a degree of ambidextrousness, which not every

surgeon has.’

SINGLE-INCISION laparoscopic surgery for colon cancer is available on the NHs and privately — it costs from £6,000. london-surgeon.com