Minimally invasive milestone

A major step forward in surgical innovation has been achieved at Medical Associates Hospital with the successful completion of its first laparoscopic colectomy, performed by consultant general surgeon Dr O’Rane Thomas. The landmark procedure marks a significant advance in minimally invasive colorectal surgery in Jamaica and forms part of the hospital’s wider clinical modernisation under Caribbean health systems.

According to Thomas, the achievement reflects deeper institutional change.

“At Medical Associates Hospital, this achievement aligns with the broader modernisation of the facility under Caribbean health systems, showing that the hospital’s rebranding is not just aesthetic but deeply clinical,” he said. “It signifies a commitment to delivering world-class patient care and positions Medical Associates as one of the leading facilities in minimally invasive surgery locally.”

A laparoscopic colectomy removes a diseased segment of the colon through small “keyhole” incisions, using a camera and specialised instruments rather than the large opening required in traditional open surgery. “This is a highly technical procedure which involves the use of a camera and specialised instruments inserted through small incisions in the abdomen,” Thomas explained. “The diseased segment of colon is detached, removed, and the bowel is rejoined internally.”

Compared with the open approach, the minimally invasive technique offers well-documented benefits. “Because the incision is much smaller, patients typically experience less pain, shorter hospital stays, a lower risk of wound infection, and a quicker return to normal activities,” he noted.

The patient in this case suffered from complicated diverticulitis, an increasingly common condition in Jamaica. “Diverticulitis is the inflammation of small pouches, called diverticula, that develop in the wall of the colon,” Thomas said. “It is commonly associated with low dietary fibre.” He added that although “up to 60 per cent of people over age 60 have diverticulosis… we are seeing an increasing number of cases in younger patients under 50, often linked to diet and obesity.”

Symptoms range from abdominal pain to changes in bowel habits, and may be accompanied by complications involving neighbouring organs. “In this patient, the inflammation was severe and led to the formation of a large abscess. The colon had also adhered to the bladder, which made the surgery particularly challenging,” he said.

Despite the complexity, the surgical team was able to remove the diseased section and restore bowel continuity in a single operation. “What made this case especially complex was the decision to perform a laparoscopic colectomy with single-stage bowel rejoining. We were able to remove the diseased section and reconnect the bowel laparoscopically in one operation, allowing the patient to avoid both a stoma bag and the need for a second surgery,” Thomas said.

The successful outcome was made possible by the hospital’s newly commissioned state-of-the-art laparoscopic tower, introduced this year. “The laparoscopic tower provided enhanced visibility and precision, which is vital for safe and effective minimally invasive surgery,” he said.

ADVANCED TECHNOLOGY

The team also relied on advanced instruments. “An advanced energy device utilising ultrasonic technology was used for cutting and sealing tissue with minimal bleeding. We also used specialised laparoscopic instruments with bipolar energy capability for precise dissection and blood control, along with advanced bowel stapling devices to securely rejoin the bowel,” he said. Together, these tools enabled greater accuracy and safety during the operation.

Traditionally, severe diverticulitis often requires a temporary colostomy to divert waste during healing. The laparoscopic method helped avoid this. “Thanks to the enhanced visibility and precise dissection offered by the laparoscopic technique, we were able to significantly reduce contamination within the abdomen. This allowed us to safely rejoin the bowel in a single stage rather than creating a temporary stoma,” Thomas said. Under the conventional approach, a stoma would typically be followed months later by a second operation to restore normal bowel continuity.

Recovery time is another notable advantage. The patient was discharged four days after surgery. “Patients are often able to leave hospital within three to four days after laparoscopic surgery. In contrast, traditional open surgery usually requires a longer hospital stay due to larger incisions and slower recovery,” Thomas explained.

Minimally invasive colorectal surgery also offers longer-term benefits. “Studies have shown that the laparoscopic approach can reduce the risk of readmission, incisional hernias, and bowel obstruction,” he added. Yet he noted that not all patients are suitable candidates. “The laparoscopic approach is ideal for patients who are hemodynamically stable, without significant chronic illness, and with minimal contamination of the abdominal cavity.”

Outcomes also depend heavily on surgical expertise and access to modern technology. “Experience and the availability of modern equipment such as laparoscopic towers and energy devices are essential,” he said.

Thomas argues that continued investment in advanced medical technology is crucial for Caribbean healthcare. “It is critically important for hospitals in the Caribbean to invest in surgical innovation and modern equipment. Modern technology allows for safer procedures, less pain, faster recovery, and shorter hospital stays,” he said. Such improvements can also ease economic pressures. “Shorter admissions and fewer complications mean lower overall costs for both patients and the health system, which is especially important in developing countries.”

Investment also helps keep specialist care within the region. “When hospitals invest in advanced equipment, patients do not have to travel abroad for complex procedures. It keeps care accessible and affordable while also encouraging skilled specialists to remain and practice in the Caribbean,” Thomas said.

While he underscores the advantages of minimally invasive techniques, Thomas notes that both approaches remain valid. “While laparoscopic colectomy offers clear benefits such as smaller incisions and faster recovery, it is not suitable for every patient,” he said. “Open colectomy is a well-established and safe procedure that continues to play a vital role in treating diverticulitis and other colorectal conditions.”

Ultimately, surgical decisions hinge on safety. “The choice depends on the patient’s overall health, the severity of the disease, and the surgeon’s judgment. Our goal is always the safest and most effective result for each individual patient,” Thomas added.

keisha.hill@gleanerjm.com