Single-Access Laparoscopic Rectal Resection Versus the Multiport Technique

Bracale, Umberto; Melillo, Paolo; Lazzara, Fabrizio; Andreuccetti, Jacopo; Stabilini, Cesare; Corcione, Francesco; Pignata, Giusto

doi:10.1177/1553350614529668

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…One RCT [103] (n = 40) and six comparative studies [104–109] (n = 670), in which SIES and multi-port rectal surgery were compared were retrieved from the literature. Three of the six comparative studies started the SIES rectal resection already with one extra port.…”

Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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BackgroundLaparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.MethodsAn expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.ResultsIn general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.ConclusionsConsidering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

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Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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“…Surgical techniques and technologies as well as perioperative care have greatly evolved over the past several decades. The laparoscopic approach is now increasingly considered the standard of care in almost all colorectal diseases due to improved short-term postoperative results with no detrimental effects on oncological outcomes when compared to open surgery[ 14 , 15 ]. Laparoscopy is associated with providing a better view of the surgical field, less intraoperative blood loss, reduced tissue trauma and lower inflammatory response[ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Sciuto

Merola²,

Palma

et al. 2018

WJG

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Every colorectal surgeon during his or her career is faced with anastomotic leakage (AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.

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“…Suggestions that SILS could be an increased burden on an already financially strained healthcare system seem unfounded, as Bracale et al . have demonstrated in a thorough cost analysis. They compared 21 SILS and 21 conventional laparoscopic anterior resections.…”

Section: Discussionmentioning

confidence: 97%

“…Vestweber et al [25] recorded the outcome for 224 patients following colorectal SILS for benign disease, all of whom reported a pain score of less than 4, on a scale of 1-10, on postoperative day 1. Suggestions that SILS could be an increased burden on an already financially strained healthcare system [6] seem unfounded, as Bracale et al [12]have demonstrated in a thorough cost analysis. They compared 21 SILS and 21 conventional laparoscopic anterior resections.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, despite a promising short‐term outcome for SILS colonic surgery, there is much less evidence for SILS applied to rectal cancer. The few studies available mostly report small case numbers and limited oncological follow‐up data. Our single‐centre experience now comprises over 200 SILS colorectal procedures, including all forms of major resection.…”

Section: Introductionmentioning

confidence: 99%

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Single‐incision laparoscopic surgery for rectal cancer: early results and medium‐term oncological outcome

2015

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Single-Access Laparoscopic Rectal Resection Versus the Multiport Technique

Abstract: We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.

Cited by 12 publications

References 32 publications

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Single‐incision laparoscopic surgery for rectal cancer: early results and medium‐term oncological outcome

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