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

Abstract

Objective: Single incision laparoscopic surgery (SILS) is a "scar-less" new surgical technique which has been gaining popularity over recent years. In comparison to conventional multiport laparoscopic surgery, SILS is introduced as a less invasive method. This technique has also been applied to colorectal surgery. The aim of the presenting study is to investigate the applicability of SILS and report short term results. Material and Methods:We evaluated prospectively collected data of 24 patients who had been operated with "Single Incision Laparoscopic Colon Resection (SILCR)" in our clinic between June 2011-June 2013. Informed consent was obtained from all patients before surgery. Patient data such as ASA and BMI values, need for additional surgery, tumors, number of lymph nodes resected, length of hospital stay, length of surgery, timing of flatus, time to start oral feeding and complications were recorded.Results: SILCR was performed in 24 patients. In 13 patients, SILCR was performed for cancer treatment. There was no need for extra ports, conversion to open surgery and stoma creation was also not necessary. Drain was placed in 4 patients. Overall complication rate was 12.5%. The mean number of lymph nodes in 13 patients who underwent SILCR for tumor was found to be 23 (14-33). The mean operative time and length of hospital stay was 177 minutes (110-363) and 5.35 days (4-11) respectively. Anastomotic leakage was not seen in any of the patients. In one patient, urinoma formation due to ureteral leakage was seen which resulted from thermal injury. Conclusion:When we compare other series with almost the same number of patients' reported SILS results in the literature, we believe that we could draw conclusions from our data. SILS appears to have comparable results to conventional multiport laparoscopic surgery in the hands of experienced surgeons. It seems advantegous as it can be done with conventional laparoscopic instruments in a "scar-less" manner. Prospective randomized trials are necessary to define the benefits of one procedure over the other. Original Investigation INTRODUCTIONExpertise in laparoscopy over 20 years and the advances in technology expand the role of NOTES and single port or single incision surgeries within the spectrum of minimally invasive surgery. This technique has rapidly gained acceptance with support from flexible hand devices, telescopes with rotating ends and port systems that can be placed through 2-5 cm incisions without gas leakage. This technique was first used in right-hemicolectomy by Remzi et al. for a large cecal polyp (1). Similar to the way laparoscopic surgery began; single incision surgery was first used in cholecystectomy and gained popularity thereafter. Colorectal procedures with this method have also begun during the same period. According to results from studies on single incision surgical procedures, this method has a slight advantage over conventional laparoscopic procedures with less pain, less length of hospital stay and faster recovery (2-4).

Fast-track versus conventional protocol in colon cancer surgery

“…Evidence-based studies have shown that changing these conventional approaches for patient care may hasten recovery, thereby reducing complications and the length of hospital stay. Different from the conventional approach, these multidirectional approaches are called fast-track surgery (FTS) (3)(4)(5)(6). Fast-track surgery is focused on achieving a faster recovery and decreasing morbidity by the use of anesthesia, analgesia, decreased surgical stress, fluid treatment, minimally invasive surgery (MIS), nutrition, and mobilization (7,8).…”