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Minimally invasive surgery

The increasing use of minimally invasive surgery in treating colorectal cancer can be attributed to revolutionary advances in surgical optics, operating platforms, laparoscopic equipment and energy devices. "Features like autofocus cameras, anti-fog lenses, flexible 3D and 4K or ultra-high definition laparoscopes provide clear views of the abdominal cavity and pelvis, allowing surgeons to perform more precise surgery," says Dr Cherylin Fu​, Consultant from the Department of Colorectal Surgery at Singapore General Hospital​, a member of the SingHealth​ group.

​New operating platforms are also available, such as robotic-assisted surgery where the surgeon sits comfortably at a console, controlling high-definition 3D cameras and fine, highly dexterous cutting instruments, to perform difficult and complex procedures like lateral pelvic node dissections.

​Meanwhile, transanal platforms and single port devices allow minimally invasive colorectal resections to be performed using smaller and fewer incisions. The use of these platforms has become increasingly popular, and has paved the way for NO TES (Natural Orifice Transluminal Endoscopic Surgery) and NOSE (Natural Orifice Specimen Extraction) to become a reality. Such techniques, where operations are performed through the body’s natural openings, were deemed dangerous and experimental not too long ago. These new technologies not only benefit patients in terms of less pain, smaller wounds, less bleeding, faster return to normal function, and fewer adhesion-related complications, but also take into consideration the well-being of surgeons in terms of better ergonomics and less surgeon fatigue.

Energy devices

Surgical instruments and energy devices are important tools in the colorectal surgeon’s practice. Increasingly, laparoscopic instruments are being developed with more ergonomic and other advanced features to make work easier for surgeons. Energy devices, which are used to cut and dissect tissue, have features such as improved vessel sealing functions to reduce bleeding while minimising thermal injury to adjacent tissues.


Technology ​has also had an impact on radiotherapy, an important component in the multi-disciplinary treatment of colorectal cancer. Whole pelvic radiotherapy used to be associated with significant adverse reactions such as rectal inflammation and bleeding. However, with targeted radiotherapy techniques, such complications have reduced significantly in the last two to three decades. Advanced radiation strategies with novel radiosensitisers, intensity modulated radiotherapy, and high-dose-rate brachytherapy, are likely to be the next step in improving treatment while simultaneously reducing radiotherapy related toxicity.

See previous page for more ​colorectal cancer treatments: surgical staplers, ultrasounds and MRI​.

Ref: O17