Single-incision laparoscopic right colectomy for cancer: a single-centre preliminary experience

Abstract

The rationale for single-incision laparoscopic surgery (SILS) is minimizing morbidity, as well as improving cosmetic results of laparoscopic approach. This technique has been used for a variety of procedures and has recently been proposed for colonic resections as well. We report our preliminary experience of right colectomy, performed through a SILS approach. Five patients (3 males, 2 females, mean age 81.6 years) were selected to undergo SILS right colectomy for cancer. The procedure was carried out through a SILS multi-port device (SILS™ Port, Covidien Ltd, Norwalk, CT, USA), with either conventional or specially designed instruments. A medial-to-lateral approach and an extra-corporeal anastomosis were performed. In three cases, the procedure was completed through the SILS technique; in two of these cases a combined procedure was carried out (right colectomy plus cholecystectomy, right colectomy plus cholecystectomy plus i.o. colonoscopy and polypectomy). In one case, a switch to standard laparoscopy was necessary because of the large dimension of the tumour, while in the other case an intolerance of pneumoperitoneum was registered, thus requiring a conversion to open surgery. SILS procedures proved to be oncologically correct. No major complications occurred. In selected patients, SILS right colectomy for cancer appears to be feasible and oncologically safe. Beyond the cosmetic advantage, the procedure may reduce postoperative morbidity. Further studies are needed, with larger series and a longer follow-up, to determine the incidence of possible long-term complications and to evaluate possible cost-effectiveness of the procedure.

Single-incision laparoscopic colectomy: technical aspects and short-term results

“…Operative times for both anterior resections and right hemicolectomies in our experience are comparable with those reported in other previously published studies [13][14][15][16]. In terms of pathological results, and especially lymph node harvest, we cannot provide definitive results given the limited number of our oncological cases.…”

Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case–control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost

“…Most of the studies' conclusions were that SILS is feasible and safe for selected patients. However, it has been reported that the advantages of SILS extend beyond cosmesis to the reduction of pain [19,24], a low complication rate [18,23], early hospital discharge [19,23,24], and reduction in medical treatment costs [19,24]. A review of 149 patients demonstrated that preliminary oncologic results showed the feasibility of SILS but concluded that standardization of the technique and careful application of SILS are needed [13].…”

“…There has been no large-scale multicenter study of the use of SILS for colorectal cancer as of yet; most reports have been clinical experiences at a single institute [17][18][19][20][21][22][23][24][25][26][27]. A recent review of SILS summarized the results from 149 patients [13].…”

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

“…However, time to oral intake as a measure of recovery of gastrointestinal function is prone to bias, as surgeons with an interest in laparoscopic surgery are likely to feed their patients earlier than those who perform open surgery [46]. Regarding SILC, in 39 cases of multi-institutional studies reviewed [47], average time to flatus and bowel movement was 2.2 and 2.9 days, respectively, a finding also supported by a single other report [48] (postoperative day 2-3 of first flatus). In the present study, there were only a few reports providing relevant data regarding recovery of gastrointestinal function after SIL-RH, defined as flatus passage, with only three studies comparing the median time to flatus passage between SIL-RH and ML-RH, concluding that the two surgical approaches are equivalent in terms of postoperative gastrointestinal function recovery, with no statistically significant difference between them.…”