Single-Incision Laparoscopic Surgeries for Colorectal Diseases: Early Experiences of a Novel Surgical Method

Abstract

Objectives. This paper aims to analyze the feasibility and safety of single-incision laparoscopic colectomy (SILC) and its potential benefits. Methods. Systematic review was performed for the years 1983–August 2011 to retrieve all relevant literature. A total of 21 studies with 477 patients undergoing SILC were selected. Results. Range of operative times and estimated blood losses were 75–229 min and 0–100 mL, respectively. Overall conversion rate was 5.9% (28/477) and an additional laparoscopic port was used in 4.9% (16/329) cases. Range of lymph node number for malignant cases was 12–24.6 and surgical margins were all negative. Overall mortality and morbidity rate was 0.4% (2/477) and 11.7% (43/368), respectively. The length of hospital stay (LOS) varied across reports (2.7–9.2 days). Among 6 case-matched studies, one showed less blood loss in SILC as compared to LAC and 2 showed shorter LOS after SILC versus HALC or LAC/HALC groups. In addition, one study reported maximum pain score on postoperative days 1 and 2 was lower in SILS compared to LAC and HALC. Conclusions. SILC procedure is feasible and safe when performed by surgeons highly skilled in laparoscopy. In spite of technical difficulties, there may be potential benefits associated with SILC over LAC/HALC.

Single-incision (with multi-input single-port) laparoscopic colorectal procedures: Early results

“…Mortality is reported to be 0-0.4% and morbidity 7.5-13% (2,11,15). There is no mortality in our series, and the morbidity rate is 12.5%.…”

“…The operation duration is reported to be between 75-229 minutes (1,7,11,(13)(14)(15)17). Although S-LCS is a more challenging technique and lasts longer than C-LCS, in our series the mean operation time was 177 minutes (3,6).…”

“…The number of lymph nodes resected varies between 12 to 38 (3,7,9,(13)(14)(15)(16). In our series a mean of 23 (14-33) lymph nodes were excised in the 13 patients with malignancy.…”

“…The late left ureteral thermal injury was accepted as a major morbidity. (8,11,14,15,17,18). We preferred to use a pelvic drain placed from the left lower quadrant in 4 of our patients after single incision surgery.…”

Z skin incision in reduced-port surgery for colorectal cancer

“…Conventional multiport laparoscopic surgery for CRC is mainly performed using five trocars, namely one for the laparoscopist, two for the operator and two for the assistant. Recently, efforts have been made to reduce the number of trocars and perform a shorter skin incision, in order to reduce wound pain and provide a better cosmetic outcome; therefore, single-incision laparoscopic surgery (SILS) and reduced-port surgery (RPS) have been applied in colectomies (3)(4)(5)(6)(7). In SILS and RPS, an umbilical incision is used for multi-trocar access, to remove the specimen and perform the anastomosis; thus, the length of the umbilical skin incision depends on these procedures.…”