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A NICE alternative to traditional surgery

Last Modified: May 19, 2021

Family Medicine

NICE procedure

Minimally invasive surgeries aren’t new. They’ve been around for years, but the NICE procedure for colorectal surgery is a cut above the rest. With significant reductions in complications, length of hospital stays and recovery, it presents a world of possibilities for many patients. For a more detailed look at this method, we turn to Sunil Reddy, MD, PPG – Colon & Rectal Surgery, as he provides answers to our questions and highlights the many benefits that accompany this innovative surgical technique.

What is the NICE procedure?

NICE stands for natural orifice intracorporeal anastomosis and extraction. The NICE procedure is a minimally invasive method of colon removal and retrieval through the rectum and anal canal.

What conditions does this type of colorectal procedure treat?

The NICE technique is an advanced, minimally invasive, robotic method used to perform a left colectomy or sigmoid colectomy. Providers often use the method for non-cancer diagnoses like diverticulitis or Crohn’s disease. Additionally, in some cases, this procedure is selectively being utilized for some small colon cancers.

How does this compare with other techniques within the field?

There’s no question that minimally invasive techniques have advanced the field of colorectal surgery. In the past, we made a few tiny incisions to mobilize and dissect the colon. However, with traditional laparoscopic and robotic colectomies, an incision of 2-3 inches is made to pull out the removed section of the colon and complete the healthy colon’s re-attachment.

Providers can avoid this by utilizing the NICE technique to remove the affected colon through the rectum and anal canal. The attachment of the remaining healthy colon then occurs within the abdomen without the need to bring out the colon through a separate larger incision. The result is a truly minimally invasive procedure with just a few tiny incisions.

What are the benefits of the NICE procedure?

Because there aren’t any large incisions, the recovery time is much faster. There’s also less requirement for pain medications, which, in turn, facilitates the early return of bowel function, allowing discharge as early as the next day.

With traditional laparoscopic or robotic colectomy surgery, patients stay in the hospital for 3-4 days and must avoid strenuous work for 6-8 weeks. With the NICE technique, patients can return to unrestricted work within one week.

This technique is also beneficial for patients with risk factors such as diabetes, obesity and breathing trouble. The risk of wound infections and hernia after surgery with the NICE technique is minimal. Additionally, from a cosmetic standpoint, the scars are tiny and barely noticeable.

How can patients prepare for the NICE procedure?

Patients who may benefit from the NICE technique should undergo a colonoscopy before surgery to rule out colon cancer since providers predominantly use the method for benign diseases of the colon.

What can someone expect after the procedure?

With traditional surgeries, patients can expect an inpatient hospital stay of 1-2 days. Typically, 4-5 small incisions are made in the upper abdomen, measuring about 5-8 millimeters in size. Usually, patients can begin a liquid diet after surgery, then eventually progress to a soft diet.

Most patients undergoing the NICE procedure colectomy can go home the next day after surgery. They are also encouraged to walk and engage in light activity at home. Within 5-7 days, patients can consume regular food, resume normal work activity and even drive.

How would someone know if this procedure was right for them?

Currently, patients in need of colon surgery for diverticulitis are ideal candidates for this surgery. A consultation with a colorectal surgeon is the first step in the treatment process, at which time we discuss treatment options and alternatives. Once colon resection is deemed necessary, we can discuss the feasibility of the NICE technique.

Final thoughts

Many patients in need of colon surgery tend to put it off because they were concerned about prolonged postoperative recovery and time off work. With the NICE technique, the recovery is faster, and there is no need for a lengthy leave of absence. Fortunately, the availability of this procedure also helps expand the treatment options for many patients.

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