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Keller DS, Reif de Paula T, Ikner TP, Saidi H, Schoonyoung H, H Marks J. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: a comparative analysis in colorectal cancer surgery. Surg Endosc 2024; 38:1568-1575. [PMID: 38177611 DOI: 10.1007/s00464-023-10629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) may offer improved cosmesis, reduced postoperative pain and faster recovery than conventional platforms, but widespread implementation was limited by technical demands. A single-port robotic platform was recently introduced, with components that further enhance SILS benefits without the technical challenges. No study to date has compared the two platforms to validate benefits. Our goal was to compare outcomes of SP robotics and SILS in colorectal cancer (CRC). METHODS A prospective cancer registry was reviewed for CRC patients undergoing curative resection through a SILS or SP robotic approach from 2010 to 2022. Patient and cancer demographics, intraoperative, and postoperative outcomes were compared in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. The main outcome measures were complications, operative time, and oncologic quality measures. RESULTS Matching resulted 50 SP robotic and 50 SILS patients. Cohorts were well matched in all demographics, but SP robotic rectal cancer cases were significantly closer to the anorectal ring than SILS (1.8 cm vs. 3.4 cm, p = 0.018). SP robotic and SILS platforms had similar operative times. Intraoperative conversions was comparable, but more SILS cases required additional ports to be placed (p = 0.040). The intraoperative complications rate, complete total mesorectal excision rates, and lymph node yield were not statistically significantly different. There were no positive margins in either group. Postoperatively, groups had analogous day of return of bowel function, comparable morbidity, and discharge destination. There was no mortality in either group. The length of stay was significantly shorter with SP robotics than SILS (mean 4.135 vs. 5.282 days, median 4 (2-8) vs. 5 (2-14) days; p = 0.045). CONCLUSIONS Single-port robotics provided high quality oncologic surgery, adding the technical benefits of robotics to clinical and cosmetic benefits of single-port surgery. There were comparable operative time, complication rates, and oncologic outcomes in CRC cases, with shorter hospital stays with SP robotics. This early data is encouraging for expansion SP robotic technology.
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Affiliation(s)
- Deborah S Keller
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Taylor P Ikner
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Hela Saidi
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Henry Schoonyoung
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - John H Marks
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA.
- Department of Surgery, Lankenau Medical Center, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
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McRae JJ, Goodman LF, Radulescu A. Sigmoid volvulus in a teenager. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Single-incision Laparoscopy Versus Multiport Laparoscopy for Colonic Surgery: A Multicenter, Double-blinded, Randomized Controlled Trial. Ann Surg 2019; 268:740-746. [PMID: 30303873 DOI: 10.1097/sla.0000000000002836] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare outcome of single-port laparoscopy (SPL) and multiport laparoscopy (MPL) laparoscopy for colonic surgery. SUMMARY OF BACKGROUND DATA Benefits of SPL over MPL are yet to be demonstrated in large randomized trials. METHODS In this prospective, double-blinded, superiority trial, patients undergoing laparoscopic colonic resection for benign or malignant disease were randomly assigned to SPL or MPL (NCT01959087). Primary outcome was length of theoretical hospital stay (LHS). RESULTS One hundred twenty-eight patients were randomized and 125 analyzed: 62 SPL and 63 MPL, including 91 right (SPL: n = 44, 71%; MPL: n = 47, 75%) and 34 left (SPL: n = 18, 29%; MPL: n = 16, 25%) colectomies, performed for Crohn disease (n = 53, 42%), cancer (n = 36, 29%), diverticulitis (n = 21, 17%), or benign neoplasia (n = 15, 12%). Additional port insertion was required in 5 (8%) SPL patients and conversion to laparotomy occurred in 7 patients (SPL: n = 3, 5%; MPL: n = 4, 7%; P = 1.000). Total length of skin incision was significantly shorter in the SPL group [SPL: 56 ± 41 (range, 30-300) mm; MPL: 87 ± 40 (50-250) mm; P < 0.001]. Procedure duration, intraoperative complication rate, postoperative 30-day morbidity, postoperative pain, and time to first bowel movement were similar between the groups, leading to similar theoretical LHS (SPL: 6 ± 3 days; MPL: 6 ± 2; P = 0.298). At 6 months, quality of life was similar between groups, but patients from the SPL group were significantly more satisfied with their scar aspect than patients from the MPL group (P = 0.003). CONCLUSION SPL colectomy does not confer any additional benefit other than cosmetic result, as compared to MPL.
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White EJ, McMahon M, Walsh MT, Coffey JC, O Sullivan L. Toward a Model of Human Information Processing for Decision-Making and Skill Acquisition in Laparoscopic Colorectal Surgery. JOURNAL OF SURGICAL EDUCATION 2018; 75:749-757. [PMID: 28986274 DOI: 10.1016/j.jsurg.2017.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/28/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To create a human information-processing model for laparoscopic surgery based on already established literature and primary research to enhance laparoscopic surgical education in this context. DESIGN We reviewed the literature for information-processing models most relevant to laparoscopic surgery. Our review highlighted the necessity for a model that accounts for dynamic environments, perception, allocation of attention resources between the actions of both hands of an operator, and skill acquisition and retention. The results of the literature review were augmented through intraoperative observations of 7 colorectal surgical procedures, supported by laparoscopic video analysis of 12 colorectal procedures. RESULTS The Wickens human information-processing model was selected as the most relevant theoretical model to which we make adaptions for this specific application. We expanded the perception subsystem of the model to involve all aspects of perception during laparoscopic surgery. We extended the decision-making system to include dynamic decision-making to account for case/patient-specific and surgeon-specific deviations. The response subsystem now includes dual-task performance and nontechnical skills, such as intraoperative communication. The memory subsystem is expanded to include skill acquisition and retention. CONCLUSIONS Surgical decision-making during laparoscopic surgery is the result of a highly complex series of processes influenced not only by the operator's knowledge, but also patient anatomy and interaction with the surgical team. Newer developments in simulation-based education must focus on the theoretically supported elements and events that underpin skill acquisition and affect the cognitive abilities of novice surgeons. The proposed human information-processing model builds on established literature regarding information processing, accounting for a dynamic environment of laparoscopic surgery. This revised model may be used as a foundation for a model describing robotic surgery.
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Affiliation(s)
- Eoin J White
- School of Design, University of Limerick, Castletroy, Co. Limerick, Ireland
| | - Muireann McMahon
- School of Design, University of Limerick, Castletroy, Co. Limerick, Ireland
| | - Michael T Walsh
- School of Engineering, University of Limerick, Castletroy, Co. Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, Co. Limerick, Ireland; Bernal Institute, University of Limerick, Castletroy, Co. Limerick, Ireland
| | - J Calvin Coffey
- Bernal Institute, University of Limerick, Castletroy, Co. Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Castletroy, Co. Limerick, Ireland; Department of Colorectal Surgery, University Hospital Limerick, University of Limerick, Castletroy, Co. Limerick, Ireland
| | - Leonard O Sullivan
- School of Design, University of Limerick, Castletroy, Co. Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, Co. Limerick, Ireland.
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Schneider B, Brockhaus AC, Gelos M, Rudroff C. The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery. Innov Surg Sci 2018; 3:77-84. [PMID: 31579769 PMCID: PMC6754045 DOI: 10.1515/iss-2017-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/29/2018] [Indexed: 11/15/2022] Open
Abstract
Background Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients. Methods Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given. Results There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS. Conclusion SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.
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Affiliation(s)
- Bernd Schneider
- SUVA (Swiss National Accident Insurance Fund), Luzern, Switzerland
| | - Anne Catharina Brockhaus
- Department of Medical Biometry, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Marcos Gelos
- Department of Surgery, Alfred Krupp Krankenhaus Steele, Essen, Germany
- Faculty of Health Sciences, University of Witten-Herdecke, Witten, North Rhine-Westphalia, Germany
| | - Claudia Rudroff
- Department of General and Visceral Surgery, Evangelische Klinik Koeln-Weyertal, Weyertal 76, D-50931Cologne, Germany
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Hoyuela C, Juvany M, Carvajal F. Single-incision laparoscopy versus standard laparoscopy for colorectal surgery: A systematic review and meta-analysis. Am J Surg 2017; 214:127-140. [DOI: 10.1016/j.amjsurg.2017.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
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Abstract
Laparoscopic surgery has revolutionized the delivery of care to the surgical patient undergoing colorectal resection. Since the first laparoscopic-assisted colectomy in 1991, significant advances have been made in minimally invasive colorectal surgery. For many benign conditions, laparoscopic colectomy has been proven to be safe and effective, and in some instances superior when compared with open surgery. Complex laparoscopic resections such as those for diverticulitis and inflammatory bowel disease have also been shown to have equivalent outcomes when compared with open surgery. Short-term benefits of a minimally invasive approach include less pain, decreased rates of wound infection and postoperative morbidity, faster return of bowel function, and shorter length of stay. Improvements in long-term complications have also been noted with lower incidence of incisional hernias and small bowel obstructions secondary to adhesions. As surgeons become more facile with laparoscopic resection, more complex cases such as those for complicated diverticulitis and reoperative surgery for inflammatory bowel disease can be completed with shorter operative times and decreased cost.
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Affiliation(s)
- Radhika Smith
- University of Chicago, Section of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | - David J. Maron
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, Florida
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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.
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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.
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Ilhan M, Gök AFK, Bademler S, Cücük ÖC, Soytaş Y, Yanar HT. Comparison of single incision and multi incision diagnostic laparoscopy on evaluation of diaphragmatic status after left thoracoabdominal penetrating stab wounds. J Minim Access Surg 2016; 13:13-17. [PMID: 27934791 PMCID: PMC5206833 DOI: 10.4103/0972-9941.194975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM: Single incision diagnostic laparoscopy (SIDL) may be an alternative procedure to multi-incision diagnostic laparoscopy (MDL) for penetrating thoracoabdominal stab wounds. The purpose of this study is sharing our experience and comparing two techniques for diaphragmatic status. MATERIALS AND METHODS: Medical records of 102 patients with left thoracoabdominal penetrating stab injuries who admitted to Istanbul School of Medicine, Trauma and Emergency Surgery Clinic between February 2012 and April 2016 were examined. The patients were grouped according to operation technique. Patient records were retrospectively reviewed for data including, age, sex, length of hospital stay, diaphragm injury rate, surgical procedure, operation time and operation time with wound repair, post-operative complications and accompanying injuries. RESULTS: The most common injury location was the left anterior thoracoabdomen. SIDL was performed on 26 patients. Nine (34.6%) of the 26 patients had a diaphragm injury. Seventy-six patients underwent MDL. Diaphragmatic injury was detected in 20 (26.3%) of 76 patients. The average operation time and post-operative complications were similar; there was no statistically significant difference between MDL and SIDL groups. CONCLUSION: SIDL can be used as a safe and feasible procedure in the repair of a diaphragm wounds. SIDL may be an alternative method in the diagnosis and treatment of these patients.
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Affiliation(s)
- Mehmet Ilhan
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Süleyman Bademler
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Cenk Cücük
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yiğit Soytaş
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Teoman Yanar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Weiss H, Zorron R, Vestweber KH, Vestweber B, Boni L, Brunner W, Sietses C, Morales Conde S, Bulut O, Gash K, Dixon AR, Mittermair C, Klaus A, Stanger O, Weiss M, Muratore A, Hell T. ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures. Br J Surg 2016; 104:128-137. [PMID: 27762435 DOI: 10.1002/bjs.10315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment. METHODS Consecutive patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal surgery-related conversion and complications. RESULTS Some 1769 patients were enrolled, 937 with benign and 832 with malignant conditions. Procedures were completed without additional trocars in 1628 patients (92·0 per cent). Conversion to open surgery was required in 75 patients (4·2 per cent) and was related to male sex and ASA fitness grade exceeding I. Conversions were more frequent in pelvic procedures involving the rectum compared with abdominal procedures (8·1 versus 3·2 per cent; odds ratio 2·69, P < 0·001). Postoperative complications were observed in a total of 224 patients (12·7 per cent). Independent predictors of complications included male sex (P < 0·001), higher ASA grade (P = 0·006) and rectal procedures (P = 0·002). The overall 30-day mortality rate was 0·5 per cent (8 of 1769 patients); three deaths (0·2 per cent; 1 blood loss, 2 leaks) were attributable to surgical causes. CONCLUSION The feasibility and safety, conversion and complication profile demonstrated here provides guidance for patient selection.
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Affiliation(s)
- H Weiss
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - R Zorron
- Department of Innovative Surgery, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - K-H Vestweber
- Department of General, Visceral and Thoracic Surgery, Klinikum Leverkusen, Leverkusen, Germany
| | - B Vestweber
- Department of General, Visceral and Thoracic Surgery, Klinikum Leverkusen, Leverkusen, Germany
| | - L Boni
- Minimally Invasive Surgery Research Centre, University of Insubria, Varese, Italy
| | - W Brunner
- Department of Surgery, Klinikum für Chirurgie Rorschach, St Gallen, Switzerland
| | - C Sietses
- Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - S Morales Conde
- Department of Surgery, Unit of Surgical Innovation in Minimally Invasive Surgery, University Hospital 'Virgen del Rocio', Seville, Spain
| | - O Bulut
- Department of Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark
| | - K Gash
- North Bristol NHS Trust, Bristol, UK
| | - A R Dixon
- North Bristol NHS Trust, Bristol, UK
| | - C Mittermair
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - A Klaus
- Department of Surgery, Sisters of Mercy Hospital, Vienna, Austria
| | - O Stanger
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - M Weiss
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - A Muratore
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - T Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
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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.
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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
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Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc 2016; 30:4697-4720. [DOI: 10.1007/s00464-016-4812-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
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Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol 2016; 22:704-717. [PMID: 26811618 PMCID: PMC4716070 DOI: 10.3748/wjg.v22.i2.704] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
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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.
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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.
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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
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Keller DS, Flores-Gonzalez JR, Sandhu J, Ibarra S, Madhoun N, Haas EM. SILS v SILS+1: a Case-Matched Comparison for Colorectal Surgery. J Gastrointest Surg 2015; 19:1875-9. [PMID: 26282851 DOI: 10.1007/s11605-015-2921-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS has comparable or improved outcomes compared to multiport laparoscopy but technical limitations when operating in the pelvis. To address these limitations, we developed an innovative SILS+1 approach using a single Pfannenstiel incision for pelvis access with one additional umbilical port. Our goal was to compare outcomes for SILS and SILS+1 in lower abdominal and pelvic colorectal surgery. METHODS Review of a prospectively maintained database identified patients who underwent an elective reduced port laparoscopic lower abdominal/pelvic colorectal procedure from 2009 to 2014. Cases were stratified by approach: SILS versus SILS+1 then matched 1:2 on age, gender, body mass index (BMI), comorbidity, and procedure. Demographic, perioperative, and postoperative outcome variables were evaluated. The main outcome measures were operative time, conversion rate, length of stay, complication, morbidity, and mortality rates. RESULTS One hundred thirty-two reduced port AR/LAR patients were evaluated-44 SILS and 88 SILS+1. The groups were similar in age, gender, BMI, and ASA class. The primary diagnosis in both cohorts was diverticulitis (90.9 % SILS, 87.5 % SILS+1), and main procedure performed an anterior rectosigmoidectomy (86.4 % SILS, 88.2 % SILS+1). Significantly more SILS+1 patients had previous abdominal surgery (p = 0.01). The operative time was significantly shorter in SILS+1 (mean 166.6 [SD 48.4] vs. 178.0 [SD 70.0], p = 0.03). The conversion rate to multiport or open surgery was also significantly lower with SILS+1 compared to SILS (1.1 vs. 11.4 %, p = 0.02). Postoperatively, the length of stay across the groups was similar. SILS trended towards higher complication and readmission rates (NS). There were no unplanned reoperations or mortality in either group. CONCLUSIONS SILS+1 facilitates pelvic and lower abdominal colorectal surgery, with shorter operative times and lower conversion rates. The additional port improved visualization and outcomes without any impact on length of stay, readmission, or complication rates.
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Affiliation(s)
| | | | | | | | | | - Eric M Haas
- Colorectal Surgical Associates, Houston, TX, USA. .,Houston Methodist Hospital, Houston, TX, USA. .,Minimally Invasive Colorectal Surgery, University of Texas Medical School, Houston, TX, USA.
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Juo YY, Luka S, Obias V. Single-incision robotic colectomy (SIRC): Current status and future directions. J Surg Oncol 2015; 112:321-5. [PMID: 26133116 DOI: 10.1002/jso.23935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022]
Abstract
By combining laparo-endoscopic single-site surgery (LESS) techniques with the da Vinci robotic platform, single-incision robotic colectomy (SIRC) aims to further minimize incision-related complications and improve cosmetic outcomes from the current standard of care, laparoscopic colectomy. While there is limited literature on SIRC, all available reports suggest SIRC to be a safe and feasible procedure in terms of perioperative outcomes. Future research should focus on further clarification of proposed benefits of SIRC such as cosmetics, ergonomics, incidence of incision-related complications, and long-term oncologic outcomes.
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Affiliation(s)
- Yen-Yi Juo
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Samuel Luka
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Vincent Obias
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
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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.
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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
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Luján JA, Soriano MT, Abrisqueta J, Pérez D, Parrilla P. Colectomía mediante puerto único vs colectomía mediante laparoscopia multipuerto. Revisión sistemática y metaanálisis de más de 2.800 procedimientos. Cir Esp 2015; 93:307-19. [DOI: 10.1016/j.ciresp.2014.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/02/2014] [Accepted: 11/10/2014] [Indexed: 01/03/2023]
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Vestweber B, Vestweber KH, Paul C, Rink AD. Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients. Surg Endosc 2015; 30:50-8. [DOI: 10.1007/s00464-015-4160-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/12/2015] [Indexed: 02/08/2023]
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Daher R, Chouillard E, Panis Y. New trends in colorectal surgery: Single port and natural orifice techniques. World J Gastroenterol 2014; 20:18104-18120. [PMID: 25561780 PMCID: PMC4277950 DOI: 10.3748/wjg.v20.i48.18104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
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Markar SR, Wiggins T, Penna M, Paraskeva P. Single-incision versus conventional multiport laparoscopic colorectal surgery-systematic review and pooled analysis. J Gastrointest Surg 2014; 18:2214-27. [PMID: 25217093 DOI: 10.1007/s11605-014-2654-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/01/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this pooled analysis is to determine the effect of single-incision laparoscopic colorectal surgery (SILC) on short-term clinical and oncological outcomes compared with conventional multiport laparoscopic colorectal surgery (CLC). METHODS An electronic search of Embase, Medline, Web of Science, and Cochrane databases was performed. Weighted mean differences (WMD) were calculated for the effect size of SILC on continuous variables and pooled odds ratios (POR) were calculated for discrete variables. RESULTS No significant differences between the groups were noted for mortality or morbidity including anastomotic leak, reoperation, pneumonia, wound infection, port-site hernia, and operative time. The benefits of a SILC approach included reduction in time to return of bowel function (WMD = -1.11 days; 95 % C.I. -2.11 to -0.13; P = 0.03), and length of hospital stay (WMD = -1.9 days; 95 % C.I. -2.73 to -1.07; P < 0.0001). Oncological surgical quality was also shown for SILC for the treatment of colorectal cancer with a similar average lymph node harvest, proximal and distal resection margin length compared to CLC. CONCLUSIONS SILC can be performed safely by experienced laparoscopic surgeons with similar short-term clinical and oncological outcomes to CLC. SILC may further enhance some of the benefits of minimally invasive surgery with a reduction in blood loss and length of hospital stay.
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Affiliation(s)
- Sheraz R Markar
- Academic Surgical Unit, 10th Floor, St Mary's Hospital, Praed Street, London, UK,
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Mittermair C, Schirnhofer J, Brunner E, Pimpl K, Obrist C, Weiss M, Weiss HG. Single port laparoscopy in gastroenterology and hepatology: A fine step forward. World J Gastroenterol 2014; 20:15599-15607. [PMID: 25400443 PMCID: PMC4229524 DOI: 10.3748/wjg.v20.i42.15599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Single incision laparoscopy (SIL) has become an emerging technology aiming at a further reduction of abdominal wall trauma in minimally invasive surgery. Available data is encouraging for the safe application of standardized SIL in a wide range of procedures in gastroenterology and hepatology. Compared to technically simple SIL procedures, the merit of SIL in advanced surgeries, such as liver or colorectal interventions, compared to conventional laparsocopy is self-evident without any doubt. SIL has already passed the learning curve and is routinely utilized in expert centers. This minimized approach has allowed to enter a new era of surgical management that can not be acceded without a fruitful combination of prudent training, consistent day-to-day work and enthusiastic motivation for technical innovations. Both, basic and novel technical specifics as well as particular procedures are described herein. The focus is on the most important surgical interventions in gastroenterology and aims at reviewing the current literature and shares our experience in a high volume center.
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Lim SW, Kim HR, Kim YJ. Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy. Ann Surg Treat Res 2014; 87:131-8. [PMID: 25247166 PMCID: PMC4170581 DOI: 10.4174/astr.2014.87.3.131] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 02/08/2023] Open
Abstract
Purpose The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. Methods Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. Results In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). Conclusion SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.
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Affiliation(s)
- Sang Woo Lim
- Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Hyeong Rok Kim
- Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Young Jin Kim
- Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea
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Cianchi F, Staderini F, Badii B. Single-incision laparoscopic colorectal surgery for cancer: State of art. World J Gastroenterol 2014; 20:6073-6080. [PMID: 24876729 PMCID: PMC4033446 DOI: 10.3748/wjg.v20.i20.6073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/05/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.
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Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 2014; 18:731-44. [DOI: 10.1007/s10029-014-1261-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
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Stewart DB, Berg A, Messaris E. Single-site laparoscopic colorectal surgery provides similar lengths of hospital stay and similar costs compared with standard laparoscopy: results of a retrospective cohort study. J Gastrointest Surg 2014; 18:774-81. [PMID: 24408181 DOI: 10.1007/s11605-013-2438-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/11/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The present study sought to compare the length of stay (LOS) and hospital costs for elective single-site (SSL) and standard laparoscopic (SDL) colorectal resections performed at a tertiary referral center. METHODS An IRB-approved, retrospective cohort study of all elective SDL and SSL colorectal resections performed from 2008 to 2012 was undertaken. Patient charges and inflation adjusted hospital costs (US dollars) were compared with costs subcategorized by operating room expense, room and board, and pharmacy and radiology utilization. RESULTS A total of 149 SDL and 111 SSL cases were identified. Compared with SSL, SDL surgeries were associated with longer median operative times (SSL: 153 min vs. SDL: 189 min, p = 0.001); however, median operating room costs were similar (p > 0.05). Median postoperative LOS was similar for both groups (SSL: 3 days; SDL: 4 days; p > 0.05). There was no difference between SSL and SDL with respect to either total patient charges (SSL: $34,847 vs. SDL: $38,306; p > 0.05) or hospital costs (SSL: $13,051 vs. SDL: $12,703; p > 0.05). Median costs during readmission were lower for SSL patients (SSL: $3,625 vs. SDL: $6,203, p = 0.04). CONCLUSIONS SSL provides similar LOS as well as similar costs to both patients and hospitals compared with SDL, making it a cost-feasible alternative.
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Affiliation(s)
- David B Stewart
- Department of Surgery/Division of Colon and Rectal Surgery, The Pennsylvania State University, Hershey Medical Center, 500 University Drive, P.O. Box 850, H137, Hershey, PA, 17033, USA,
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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2013; 28:89-101. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2012. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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