What Are the Benefits of Minimally Invasive Colorectal Surgery?

Pictured: Julio Garcia-Aguilar

Julio Garcia-Aguilar, Chief of the Colorectal Service in the Department of Surgery

Colonoscopy and other screening tests can detect colorectal cancer — the third most common cancer in the United States — at earlier stages than ever before, meaning more of these tumors can be removed using minimally invasive surgery.

Minimally invasive approaches differ from traditional open surgery in that they require only a few tiny incisions instead of one long one; for colon and rectal cancer patients, the options include laparoscopy and robotic surgery. Both techniques allow surgeons to remove tumors using a camera and surgical instruments inserted into keyhole-size incisions. Robotic surgery offers a three-dimensional view of organs and is believed to be more precise in experienced hands.

Memorial Sloan Kettering is the largest center in the Northeast for all types of minimally invasive colorectal surgery, and in 2013 led the nation in sheer volume of robotic colon and rectal surgeries, with more than 250 performed.

We asked Julio Garcia-Aguilar, Chief of the Colorectal Service in Memorial Sloan Kettering’s Department of Surgery, to describe the differences between laparoscopy and robotic surgery and to explain which patients are the best candidates for these procedures.

For Colon Cancer, Laparoscopy Proven Effective

Since its introduction about 20 years ago, laparoscopic surgery for colon cancer has consistently shown long-term survival rates comparable to open surgery.

Dr. Garcia-Aguilar credits greater use of screening colonoscopy for the increased detection of smaller colon tumors, which are more easily removed laparoscopically than advanced lesions that have spread beyond the colon to surrounding organs or structures. Colonoscopy use over the past decade has tripled among those aged 50 to 75, to 55 percent in 2010, according to the American Cancer Society.

“Most colon cancers today can be removed laparoscopically,” says Dr. Garcia-Aguilar. “Patients with tumors that are locally advanced or too large might not be the best candidates for a laparoscopic approach and may need open surgery. But today most colon cancers are diagnosed when they’re still localized and potentially removable using minimally invasive techniques.”

Using laparoscopy for rectal cancer is more challenging compared with colon cancer because of the rectum’s location in the bony pelvis, Dr. Garcia-Aguilar notes. But, as with colon cancer, patients with rectal tumors are typically considered for laparoscopic surgery if the cancer hasn’t spread beyond the rectum itself.

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Robotic Surgery Offers 3-D View

Robotic surgery is similar to laparoscopy, but instead of the surgeon’s hands directly controlling the instruments, robotic arms are attached to the camera and surgical tools. The surgeon views a highly magnified, three-dimensional image of the patient’s organs while using finger controls to maneuver the instruments.

The robotic technique hasn’t been around for as many years as laparoscopy, Dr. Garcia-Aguilar says, but newer add-on “gadgetry” has adapted the equipment well for colorectal cancers.

“Initially the robot was used mainly to remove tumors in the rectum, and we only recently have been applying it to the colon,” he says. “Laparoscopy is like operating using long chopsticks, but robotic surgery is more precise, and is probably a more sophisticated way of doing minimally invasive surgery.”

Dr. Garcia-Aguilar acknowledges that a surgeon’s experience with the technique is critical to its success. All six colorectal surgeons at Memorial Sloan Kettering are trained to perform robotic surgery in addition to the laparoscopic approach, he says.

“We can’t claim right now that robotic surgery is better than laparoscopy because most operations are still performed open or laparoscopically,” he adds. “We have not operated on enough patients with the robot to compare the results with patients treated laparoscopically. My personal opinion, however, is that it’s a better way to perform minimally invasive surgery.”

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Many Benefits to Minimally Invasive Approach

With a recurrence rate equal to that of open surgery and a thorough selection process to identify the best patients for minimally invasive colorectal surgery, Dr. Garcia-Aguilar says he sees no drawbacks to the approach.

The use of several small incisions instead of a single large one means less blood loss and postoperative pain for patients, as well as shorter hospital stays and lower infection rates. Additionally, patients undergoing minimally invasive surgery have a lower risk of abdominal hernia and a better cosmetic result, Dr. Garcia-Aguilar says.

“Laparoscopy is also probably more cost effective compared to open surgery because the higher cost of using special equipment in the operating room is offset by the patient’s faster recovery,” he says. “We suspect the same is true of robotic surgery. The benefits of minimally invasive surgery are real.”

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That's my doc! Awesome article!

Dr Garcia-Aguilar was my surgeon and he is not only the best surgeon but also as a human being he pays so much attention to detail of a patient well being and every aspect of the patient recovery. God bless him, his crew and everyone at MSKCC.

Enrique, thank you so much for your comment!

What is the difference between laparoscopic surgery and lasso cauterization of a polyp first done by dr. Hiromi Shinya?

Bess, thank you for your comment.

Laparoscopic surgery for colorectal cancer is a type of minimally invasive surgery in which a thin, lighted tube with a camera at its tip (called a laparoscope) is inserted through a small incision in the abdomen. The camera projects a magnified, high-definition image of the surgical area onto a screen. Using the image as a guide, the surgeon uses specialized surgical instruments to perform the surgery.

Lasso cauterization of a polyp is simply a procedure used during a standard colonoscopy (which is not surgery) to remove polyps so they can be examined. This removal of polyps has been shown to significantly reduce the risk of developing colorectal cancer.

Dr. Garcia was my husband's surgeon; he is excellent and a very caring person! Dr. Garcia is very passionate towards his patients, treating my husband as though he were a family member. Thank you for all your help, Dr. Garcia!


what kind of surgeon typically removes a possible tail gut cyst in presacral area? ( a coloreactal surgeon?)and also can tail gut tumor removal be done by laparoscopy (minimally invasive techniques)?

Sue, we are looking into this and will follow up when we have more information for you. Thank you for your comment.

From the moment I met Dr. Garcia I knew I made the best decision in coming this far for my surgery and treatment. Dr. Garcia and his staff accommodates every question my wife and myself had from the moment we step into his office. Thank you for everything Dr Garcia. God bless.

Dear Sir/ Madam
I am trying to get in touch with Dr Aguilar whom I have worked with in 1997 whilst a fellow at the university of minneapolis. Would appreciate a connection. Sorry that I am using this blog but did not see another way of emailing a contact.
Best Regards

What about when the cancer has spread to the lungs and even worse and there is a tumor in the pleura lies against one ore more ribs, is this a method that can be used to get rid of this kind of tumor also?
Best regards

Jorge, unfortunately we are unable to answer questions about specific medical cases on our blog. If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

I have a tumor very close to the rectal opening. The surgeon I was sent to just wants to cut everything out and close up the opening permanently, taking away my quality of life,. I am getting radiation and am on Chemo pills for the next few months to shrink it. The Cancer did not get out of the Colon and this seems really extreme to me. I do not have any insurance except Medicare A, and wish I could come to Memorial SC. My husband was treated there 25 years ago and survived Bladder
Cancer. This surgeon will guarantee me a miserable life until I die if he gets to operate. I am sick just thinking about this. Where is your fairy Godmother when you really need her?

Dear Shirley, we are sorry to hear about your diagnosis. Our physicians understand the importance of preserving quality of life and do everything possible to do that for their patients. If you would like to make an appointment for a consultation with one of our specialists, please call our Physician Referral Service at 800-525-2225. They can also answer some of your insurance-related questions.

You may also get more information here: http://www.mskcc.org/cancer-care/hospital-information/insurance-billing

We also offer financial assistance to patients in need. Learn more at http://www.mskcc.org/cancer-care/hospital-information/financial-assista…

We hope this is helpful. Thank you for reaching out to us.

25 yrs. ago Dr. Fair stopped bladder cancer in my husband. He is today a survivor. I have been diagnosed with Rectal cancer, and this Dr. Garcia Aquilar has the skill and expertize to give me a quality life after surgery, unfortunately I called and Warren Buffett would have to pay the asking price for saving my life, I can't. Life can be cruel and definitely not fair. I contributed to Sloan Kettering Memorial for years before we retired. I probably should have saved the money because I sure could use it now.

Dr. Garcia operated on my mother today for a difficult case of rectal cancer, and all went well. Dr. Garcia, his staff, and every member of MSKCC have been wonderful throughout the year.

When I read Enrique Katz' comment about Dr. Garcia-Aguilar's professionalism and humanity I completely agreed. He and his outstanding team strive for excellence, and there is a sense of peace and love that pervades their operating room. Dr. Garcia-Aguilar has blessed hands full of ability and dignity like wings of eagles. His staff of doctors, health professionals and administrative professionals take care of business and care for patients.

I have just had a colonoscopy today and to my shock my Dr. told me that I have a mass in my lower colon area and it looks suspect. I am having a CATscan on Monday March 9th…I would love to know how difficult it is to get an appointment with Dr. Garcia-Aguilar…is there a long wait time? In case I need him, we don't know for sure yet, I would love to see him. Hoping I don't need to but nice to know he would be there; especially after reading the reviews from patients that have had the good fortune of finding him. Thank you, Irene

Irene, thank you for reaching out. Hoping the scan results turn out well for you, but if you would like a consultation, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Unfortunately it is hard to predict wait times but patients often can get an appointment quickly.

Dr. Paty performed robotic surgery on my T3 rectal tumor less then 4 weeks ago and I couldn't be happier with the outcome. I was off of pain meds within 24 hours, left the hospital in 3 days, and haven't looked back. So blessed to have such a fantastic hospital, physicians, nurses and staff to care for me these last 9 months. And, more importantly, I am now cancer free!

Dear Amber, we are so glad to hear that your surgery went well and that you felt well-cared for by Dr. Paty! Wishing you our very best as you continue into your survivorship. Thank you for your comment!

I was recently diagnosed with rectal cancer close to the anus. I have gotten 3 different opinions and all surgeons agree that following the chemo/radiation treatments I'm undergoing right now, I'm looking at surgery and a permanent colostomy. Wondering if none of these doctors recommended a J-pouch or something less life-changing if that is because of their lack of experience or if this is truly my fate? One of the doctors lists sphincter preservation as a specialty. Just wanted to get another opinion.

Jay, if you’d like to arrange for a consultation at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. If you are not in the New York area and not able to travel here, you might want to look for a National Cancer Institute-designated cancer center in your area. You can find a list here: http://www.cancer.gov/research/nci-role/cancer-centers/find Thank you for your comment.

Is it possible for foreigners (Danish) to get non-invasive surgery with Dr. Garcia?
It is probably in the appendix or colon.

Dr Aguilar is The best. Hands down saved my life. 3.5 years out of surgery and feeling great. 41 year old male.

Dear Scott, we are happy to know that you felt well-cared for by Dr. Aguilar and that you’re doing well. Thank you for your kind words!

I was diagnosed w stage 4 colon cancer in March....Dr. Garcia was my surgeon and did a great job and put me at ease when I was a mental disaster..he cares,he shows compassion,and is a warrior in operating room.Thank you Garcia

Dear Mike, we are so pleased to hear that you were happy with your care. We will forward your comment to your doctor and his team. Best wishes to you.

Dr. Garcia-Aguilar is my rectal cancer surgeon. As a result f my substantial research, I am absolutely certain that if I am alive five years from now—[the standard measure of successful cancer surgery]—it will be primarily due to his skill as a robotic surgeon who clearly merits his reputation as a preeminent world class skilled surgeon. The criticism I lodge is partially a compliment but also is in fact a criticism. Dr. Garcia-Aguilar is, if anything, “too caring”. He twice returned my phone calls after 8P.M., once on a Saturday night after he returned from a week long medical conference. He cares “too much”——he needs to delegate more to other doctors.

Dear Philip, thank you for sharing your experiences. We will forward your comment to Dr. Garcia-Aguilar. Best wishes to you.

Dear Dr. Garcia-Aguilar,
My name is Luisa Rodriguez.
I received my pathology report from my biopsy. Diagnosis: high grade dysphasia strongly suspicious for underlying invasive adenocarcinoma in the proximal ascending colon.
I have been recommended for a colon resection. Since it seems this is early stage 1, does it matter if the surgery is performed by a colon rectal surgeon in NJ? If outcome of surgery results in additional oncology care would Sloan accept me as a patient? Or is it best to have Sloan manage from the onset? I would appreciate a 2nd opinion sooner rather than later. Thank you for your consideration. Luisa

Dear Luisa, we’re sorry to hear about your diagnosis. If you would like to speak with someone about arranging an appointment with one of MSK’s colorectal cancer experts, you can call 800-525-2225. The oncology experts who answer the phone there will be able to answer many of your questions about the timing of your treatment. You can also go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you.

I have rrctal cancer stage 3b. I wish to be treated at MSK. How much will this cost?
Please I need urgent response as we have been looking at going to India.