1
|
Suzuki Y, Tei M, Wakasugi M, Ohtsuka M, Hagihara K, Ikenaga M, Yanagimoto Y, Yamashita M, Shimizu J, Akamatsu H, Tomita N, Imamura H. Single-incision Laparoscopic Colonic Surgery: A Systemic Review, Meta-analysis, and Future Prospect. J Anus Rectum Colon 2024; 8:48-60. [PMID: 38689785 PMCID: PMC11056536 DOI: 10.23922/jarc.2023-078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 05/02/2024] Open
Abstract
Although single-incision laparoscopic surgery (SILS) has gained some attention as a feasible alternative to conventional multiport laparoscopic surgery (MPLS) in colonic surgery, it became less prevalent than expected. Hence, we conducted this systematic review to evaluate the feasibility, safety, and oncological outcomes of single-incision laparoscopic colectomy (SILC) with meta-analysis and discussion of the future prospect of SILS. The search was conducted from September to October 2023 using PubMed and the Cochrane Central Register of Controlled Trials. Articles on colorectal cancer comparing SILC with multiport laparoscopic colectomy (MPLC) from all randomized controlled trials and comparative studies with 50 patients or more per arm were examined. The primary outcomes were the intra- and postoperative complication rates, and the secondary outcomes were the perioperative and oncological outcomes. The trends of the SILS number in Japan and the trends of the number of articles on SILS in PubMed were also reviewed. There were no significant differences in perioperative complication rates, operative factors, and oncological outcomes between SILC and MPLC, although heterogeneity was observed mainly in operative factors and the total length of the skin incision was significantly shorter in SILC. Therefore, SILC is technically and oncologically feasible and safe when performed by experienced laparoscopic surgeons. The case number of SILS was gradually increasing but the rate of SILS was decreasing in Japan. The number of articles on SILS was also decreasing. SILS has gained foothold to some extent but has plateaued. The emerging new robotic platform may reappraise the concept of SILS.
Collapse
Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Kindai Nara Hospital, Nara, Japan
| | - Kiyotaka Hagihara
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Junzo Shimizu
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Japan Community Health Care Organization Osaka Minato Central Hospital, Osaka, Japan
| | - Naohiro Tomita
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
- Cancer Treatment Center, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| |
Collapse
|
2
|
Tei M, Suzuki Y, Ohtsuka M, Iwamoto K, Naito A, Imasato M, Mizushima T, Akamatsu H. Clinical outcomes of single incision laparoscopic surgery for colorectal cancer: A propensity score-matched analysis between well-experienced and novice surgeons. Ann Gastroenterol Surg 2022; 7:102-109. [PMID: 36643373 PMCID: PMC9831886 DOI: 10.1002/ags3.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Single incision laparoscopic surgery (SILS) is a recent advancement in minimally invasive techniques for colorectal cancer (CRC). However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for CRC performed by novice surgeons compared with those performed by well-experienced surgeons. Methods We retrospectively analyzed 1004 consecutive patients with stage I-IV CRC who underwent SILS between May 2009 and December 2018, using propensity score-matched analysis. Results After propensity score-matching, we enrolled 344 patients (n = 172 in each group). Before matching, significant group-dependent differences were observed in terms of age (P = 0.034) and tumor location (P < 0.001). After matching, preoperative clinical factors were similar between groups, but operative time was longer in the Novice group (213 vs 171 min, P < 0.001). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the Novice group (23 vs 25, P = 0.040), and the number of patients with lymph node metastases was smaller in the Novice group (57 vs 86, P = 0.002). The 3-year disease-free survival rate was 85.8% in the Novice group and 89.9% in the Experienced group (P = 0.512). Three-year overall survival rate was 92.2% in the Novice group and 90.0% in the Experienced group (P = 0.899). Conclusion SILS for CRC was safely performed by novice surgeons under the guidance of well-experienced surgeons, and could provide satisfactory oncological outcomes.
Collapse
Affiliation(s)
| | - Yozo Suzuki
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | | | | | - Atsushi Naito
- Department of SurgeryOsaka Police HospitalOsakaJapan
| | | | | | - Hiroki Akamatsu
- Department of SurgeryOsaka Minato Central HospitalOsakaJapan
| |
Collapse
|
3
|
Leo CA, Samaranayake SF, Chandrasinghe PC, Shaikh IA, Hodgkinson JD, Warusavitarne JH. Single Port Laparoscopic Surgery for Complex Crohn's Disease Is Safe with a Lower Conversion Rate. J Laparoendosc Adv Surg Tech A 2017; 27:1095-1100. [PMID: 28475480 DOI: 10.1089/lap.2016.0567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Cosimo Alex Leo
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
- Imperial College of London, London, United Kingdom
| | - Sanjeev F. Samaranayake
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
| | - Pramodh C. Chandrasinghe
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
| | - Irshad A. Shaikh
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
| | - Jonathan D. Hodgkinson
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
- Imperial College of London, London, United Kingdom
| | - Janindra H. Warusavitarne
- Department of Surgery, St. Mark's Hospital Academic Institute, London North West NHS Trust, Harrow, United Kingdom
| |
Collapse
|
4
|
Tominaga T, Nonaka T, Wakata K, Kunizaki M, Tobinaga S, Sumida Y, Hidaka S, Sawai T, Nagayasu T. Single-incision laparoscopic ileocecal resection using an organ retractor. Int J Surg Case Rep 2017; 33:84-88. [PMID: 28285210 PMCID: PMC5350497 DOI: 10.1016/j.ijscr.2017.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Single-incision laparoscopic surgery has been reported to be a safe and feasible technique for colorectal cancer. However, the technique needs skill due to the limitations of the device. An organ retractor is a new grasp device that has the potential to overcome these limitations. PRESENTATION OF CASE A 63-year-old woman with a tumor palpated in the right lower quadrant of the abdomen presented to hospital. Colonoscopy showed a type 2 mass with nearly complete stenosis, and a biopsy specimen showed well-differentiated adenocarcinoma. Single-incision laparoscopic surgery ileocecal resection was performed using an organ retractor. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted. An organ retractor was used for hepatocolic ligament resection, resection of the ileocolic vessels, and resection of the insertion of the mesentery proper. For each resection, the trailer line's tension was adjusted to provide a good operative view. The patient's postoperative course was good, and she was discharged 7days after surgery. DISCUSSION An organ retractor was effective for single-incision laparoscopic surgery technique not only to maintain a good operative view, but also to change trailer line tension, which enabled safe dissection. CONCLUSION An organ retractor could facilitate single-incision laparoscopic surgery.
Collapse
Affiliation(s)
- Tetsuro Tominaga
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kouki Wakata
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Masaki Kunizaki
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shuichi Tobinaga
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yorihisa Sumida
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shigekazu Hidaka
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Terumitsu Sawai
- Departments of Cardiopulmonary Rehabilitation Science, Division of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takeshi Nagayasu
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| |
Collapse
|
5
|
Brockhaus AC, Sauerland S, Saad S. Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease: a systematic review, meta-analysis and assessment of the evidence. BMC Surg 2016; 16:71. [PMID: 27756272 PMCID: PMC5070079 DOI: 10.1186/s12893-016-0187-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/12/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic colectomy (SILC) requires only one umbilical port site and (depending on technique) a specimen extraction site. The aim of this study was the assessment of the available evidence for the comparison of SILC to conventional multi-port laparoscopic colectomy (MLC) in adult patients, in whom elective colectomy is indicated because of malignant or benign disease. First, previous meta-analyses on this topic were assessed. Secondly, a systematic review and meta-analysis of randomised controlled trials, was performed. METHODS Electronic literature searches (CENTRAL, MEDLINE and EMBASE; up to March 2016) were performed. Additionally, we searched clinical trials registries and abstracts from surgical society meetings. For meta-analysis, risk ratios (RR) or mean differences (MD) with 95 % confidence intervals were calculated and pooled. The quality of previous meta-analyses was evaluated against established criteria (AMSTAR) and their reported results were investigated for consistency. RESULTS We identified 6 previous meta-analyses of mostly low methodological quality (AMSTAR total score: 2 - 5 out of 11 items). To fill the evidence gaps, all these meta-analyses had included non-randomised studies, but usually without assessing their risk of bias. In our systematic review and meta-analysis of randomised controlled trials exclusively, we included two randomised controlled trials with a total of 82 colorectal cancer patients. There was insufficient evidence to clarify whether SILC leads to less local complications (RR = 0.52, 95 % CI 0.14 - 1.94) or lower mortality (1 death per treatment group). Length of hospital stay was significantly shorter in the SILC group (MD = -1.20 days, 95 % CI -1.95 to -0.44). One of the two studies found postoperative pain intensity to be lower at the first day. We also identified 7 ongoing trials with a total sample size of over 1000 patients. CONCLUSION The currently available study results are too sparse to detect (or rule out) relevant differences between SILC and MLC. The quality of the current evidence is low, and the additional analysis of non-randomised data attempts, but does not solve this problem. SILC should still be considered as an experimental procedure, since the evidence of well-designed randomised controlled trials is too sparse to allow any recommendation.
Collapse
Affiliation(s)
- Anne Catharina Brockhaus
- Department of Medical Biometry, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany. .,Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
| | - Stefan Sauerland
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Stefan Saad
- Department of General, Abdominal, Vascular and Thoracic Surgery, Academic Hospital University Cologne, Cologne, Germany
| |
Collapse
|
6
|
Walker AS, Steele SR. The future of robotic instruments in colon and rectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Effect of BMI on Short-Term Outcomes with Robotic-Assisted Laparoscopic Surgery: a Case-Matched Study. J Gastrointest Surg 2016; 20:488-93. [PMID: 26704536 DOI: 10.1007/s11605-015-3016-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many benefits of minimally invasive surgery are lost in the obese, but robotic-assisted laparoscopic surgery (RALS) may offer advantages in this population. Our goal was to compare outcomes for RALS in obese and non-obese patients. METHODS A prospective database was reviewed for colorectal resections using RALS. Patients were stratified into obese (BMI > 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)), then case-matched for comparability. The main outcome measures were operative time, conversion rate, length of stay and complication, readmission, and reoperation rates between groups. RESULTS Forty-five patients were evaluated in each cohort. The BMI was significantly different (p < 0.01). All other demographics were well matched. There were no significant differences in operative time (p = 0.86), blood loss (p = 0.38), intraoperative complications (p = 0.54), or conversion rates (p = 0.91) across cohorts. Length of stay was comparable between groups (p = 0.45). Postoperatively, the complication (p = 0.87), readmission (p = 1.00), and reoperation rates (p = 0.95) were similar. There were no mortalities. For malignant cases (37.8 %), the lymph node yield (p = 0.48) and positive margins (p = 1.00) were similar and acceptable in both cohorts. CONCLUSIONS In our matched RALS series, perioperative and postoperative outcomes were similar between obese and non-obese patients undergoing colorectal surgery. RALS is a feasible option in the surgical setting of the obese patient. Further controlled studies are warranted to explore the full benefits.
Collapse
|
8
|
Tokuoka M, Ide Y, Hirose H, Takeda M, Hashimoto Y, Matsuyama J, Yokoyama S, Fukushima Y, Sasaki YO. Resident training in single-incision laparoscopic colectomy. Mol Clin Oncol 2016; 3:1221-1228. [PMID: 26807224 PMCID: PMC4665728 DOI: 10.3892/mco.2015.649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/28/2015] [Indexed: 01/04/2023] Open
Abstract
Single-incision laparoscopic colectomy (SLC) is touted as an improved approach to minimally invasive surgery, although no data currently exist regarding the acquisition of this technique. The aim of this study was to evaluate resident performance and outcomes in patients undergoing SLC performed by residents vs. staff colorectal surgeons. A retrospective case-control study was conducted, including 220 patients who underwent elective surgical intervention with multiport laparoscopic colectomy (MLC, n=141) or SLC (n=79) for colon cancer over a 24-month period at Yao Municipal Hospital (Yao, Japan). Data on patient demographics, operative data, oncological outcomes and short-term outcomes were evaluated for statistical significance. To investigate issues regarding the surgical procedures, the entire operation was recorded on video for all patients and was divided into 6 procedures, with each procedure measured in seconds. Senior-level residents were able to safely perform MLC under appropriate experienced supervision. For SLC, 1 case required conversion to an open procedure. No case required additional trocar placement. The mean operative times were similar for the staff and resident groups for total colon cancer (192.5 and 217.5 min, respectively; P=0.88), whereas the operative times of the staff group for right-sided colon cancer were significantly longer, and the operative times of the resident group for left-sided colon cancer were significantly longer. In addition, the overall perioperative outcomes, including blood loss, number of harvested lymph nodes, length of the surgical margin and complications, were similar between the two groups. When video recordings were evaluated by dividing the surgical process for the right colon into 4 procedures and that for the left colon into 6 procedures, the results demonstrated that the residents required more time to close the mesenteric margin for the left colon compared with the staff performing the same procedure (3,470.1±1,258.5 vs. 5,218.6±2,341.2 sec; P=0.01). Therefore, senior-level residents were able to safely perform SLC under appropriate experienced supervision. For the left colon, the main challenge for the residents appeared to be the closure of the mesenteric margin. Our data support that it is possible to train senior residents to complete a SLC safely and with the same efficacy as staff surgeons.
Collapse
Affiliation(s)
- Masayoshi Tokuoka
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Yoshihito Ide
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Hajime Hirose
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Mitsunobu Takeda
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Yasuji Hashimoto
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Jin Matsuyama
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Shigekazu Yokoyama
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Yukio Fukushima
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Y O Sasaki
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| |
Collapse
|
9
|
Keller DS, Flores-Gonzalez JR, Ibarra S, Haas EM. Review of 500 single incision laparoscopic colorectal surgery cases - Lessons learned. World J Gastroenterol 2016; 22:659-667. [PMID: 26811615 PMCID: PMC4716067 DOI: 10.3748/wjg.v22.i2.659] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/09/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Single incision laparoscopic surgery (SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.
Collapse
|
10
|
Gash K, Bicsak M, Dixon A. Single-incision laparoscopic surgery for rectal cancer: early results and medium-term oncological outcome. Colorectal Dis 2015; 17:1071-8. [PMID: 26076762 DOI: 10.1111/codi.13034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/27/2015] [Indexed: 12/20/2022]
Abstract
AIM Conventional laparoscopic surgery for rectal cancer management is now widely accepted as an alternative to open surgery, bestowing specific advantages without causing detriment to oncological outcome. Evolving from this, single-incision laparoscopic surgery (SILS) has been successfully utilized for the removal of colonic tumours, but the literature lacks data analysing the suitability of SILS for rectal cancer resection, particularly on oncological outcome. We report the medium-term oncological outcome from a prospective observational study of SILS for rectal cancer, including high and low anterior resections. METHOD A prospective electronic database was collated of all patients undergoing SILS rectal cancer resection in our institution, between 2009 and 2014. In addition to patient, tumour and operative data, histopathological and medium-term oncological end-points were recorded. Kaplan-Meier curves were used to analyse survival. RESULTS Sixty-one patients underwent SILS for rectal cancer by high anterior resection (n = 34), low anterior resection with total mesorectal excision (TME) (n = 24) and low anterior resection with TME and hand-sewn colo-anal anastomosis (n = 3). The median operation time was 105 (37-280) min and 92% of cases were completed by SILS. The mean interval to resuming oral feeding was 11 h and the median length of stay was 2 (1-8) days. The median number of lymph nodes found by the histopathologist in the resected specimen was 18 (6-44) and all operations completely removed the tumour (R0 resection). At a median follow-up of 46 (16-64) months, eight (13%) patients developed metastatic disease, of whom three had local recurrence. Overall, three patients have died, of whom all had metastatic disease. CONCLUSION Anterior resection with TME for rectal cancer can be safely performed using the SILS technique, with acceptable histopathological results and good oncological outcome.
Collapse
Affiliation(s)
- K Gash
- Department of Colorectal Surgery, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | | | - A Dixon
- Department of Colorectal Surgery, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK.,SPIRE* Hospital, Bristol, UK
| |
Collapse
|
11
|
Keller DS, Haas EM. Single-Incision Laparoscopic Colon and Rectal Surgery. Clin Colon Rectal Surg 2015; 28:135-9. [PMID: 26491404 DOI: 10.1055/s-0035-1555004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Single-incision laparoscopic surgery (SILS) was introduced to further the enhanced outcomes of multiport laparoscopy. Multiple studies have demonstrated the safety and feasibility of SILS for both benign and malignant colorectal disease. SILS provides the potential for improved cosmesis, postoperative outcomes, and patient quality of life. However, widespread use has been limited by technical demands and lack of an evidence and competency-based curriculum.
Collapse
Affiliation(s)
| | - Eric M Haas
- Colorectal Surgical Associates, Ltd, LLP, Houston, Texas ; Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas ; Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
12
|
Madhoun N, Keller DS, Haas EM. Review of single incision laparoscopic surgery in colorectal surgery. World J Gastroenterol 2015; 21:10824-9. [PMID: 26478673 PMCID: PMC4600583 DOI: 10.3748/wjg.v21.i38.10824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/08/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.
Collapse
|
13
|
Keller DS, Ibarra S, Flores-Gonzalez JR, Ponte OM, Madhoun N, Pickron TB, Haas EM. Outcomes for single-incision laparoscopic colectomy surgery in obese patients: a case-matched study. Surg Endosc 2015; 30:739-744. [PMID: 26092004 DOI: 10.1007/s00464-015-4268-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/01/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients. METHODS Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)) and then matched on patient characteristics, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were operative time, length of stay (LOS), and conversion, complication, and readmission rates for each cohort. RESULTS A total of 160 patients were evaluated-80 in each cohort. Patients were well matched in demographics, diagnosis, and procedure variables. The obese cohort had significantly higher BMI (p < 0.001) and ASA scores (p = 0.035). Operative time (176.9 ± 64.0 vs. 144.4 ± 47.2 min, p < 0.001) and estimated blood loss (89.0 ± 139.5 vs. 51.6 ± 38.0 ml, p < 0.001) were significantly higher in the obese. There were no significant differences in conversion rates (p = 0.682), final incision length (p = 0.088), LOS (p = 0.332), postoperative complications (p = 0.430), or readmissions (p = 1.000) in the obese versus non-obese. Further, in malignant cases, lymph nodes harvested (p = 0.757) and negative distal margins (p = 1.000) were comparable across cohorts. CONCLUSIONS Single-incision laparoscopic colectomy in obese patients had significantly longer operative times, but comparable conversion rates, oncologic outcomes, lengths of stay, complication, and readmission rates as the non-obese cohorts. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILS may be the ideal platform to optimize outcomes in colorectal surgery. With additional operative time, the obese can realize the same clinical and quality benefits of minimally invasive surgery as the non-obese.
Collapse
Affiliation(s)
| | | | | | | | | | - T Bartley Pickron
- Colorectal Surgical Associates, Houston, TX, USA.,Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, 7900 Fannin, Suite 2700, Houston, TX, 77030, USA
| | - Eric M Haas
- Colorectal Surgical Associates, Houston, TX, USA.,Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, 7900 Fannin, Suite 2700, Houston, TX, 77030, USA
| |
Collapse
|
14
|
Aytac E, Turina M, Gorgun E, Stocchi L, Remzi FH, Costedio MM. Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy. Surg Endosc 2014; 28:2884-9. [PMID: 24853841 DOI: 10.1007/s00464-014-3542-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/07/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Obese patients pose additional operative technical difficulties, and it is unclear if the outcomes of single-port colorectal surgery are equivalent to those of conventional laparoscopy in such patients. The aim of this study was to compare perioperative variables and short-term outcomes of single-port versus conventional laparoscopy in obese patients undergoing colorectal surgery. PATIENTS AND METHODS Obese patients (BMI ≥ 30 kg/m(2)) undergoing single-port laparoscopic colorectal resections between March 2009 and September 2012 were case matched 1:1 with obese counterparts undergoing conventional (multi-port) laparoscopic surgery based on diagnosis and operation type. RESULTS Thirty-seven patients who underwent single-port surgery were matched with 37 conventional laparoscopic counterparts. Male gender predominated in the single-port group (26 vs 15, p = 0.02). The number of patients with a history of previous abdominal operations (17 vs 13, p = 0.48) and ASA score (3 vs 2, p = 0.6) were similar between the groups. No differences were observed with respect to conversion rate (2 vs 5, p = 0.43), operative time (146 vs 150 min, p = 0.48), estimated blood loss (159 vs 183 ml, p = 0.99), time to first flatus (3 vs 3 days, p = 0.91), time to first bowel movement (3 vs 4 days, p = 0.62), length of hospital stay (7 vs 6 days, p = 0.37), or reoperation (2 vs 1, p > 0.99), and readmission rates (2 vs 2, p > 0.99). There were no deaths. CONCLUSION For obese patients undergoing colorectal resections, single-port laparoscopy appears to be as safe and effective as conventional laparoscopy.
Collapse
Affiliation(s)
- Erman Aytac
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Main Campus Mail Code A30, 9,500 Euclid Ave., Cleveland, OH, 44195, USA
| | | | | | | | | | | |
Collapse
|