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Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, Arolfo S, Yehuda AB, Boni L, Cassinotti E, Dapri G, Yang T, Fransen S, Forgione A, Hajibandeh S, Hajibandeh S, Mazzola M, Migliore M, Mittermair C, Mittermair D, Morandeira-Rivas A, Moreno-Sanz C, Morlacchi A, Nizri E, Nuijts M, Raakow J, Sánchez-Margallo FM, Sánchez-Margallo JA, Szold A, Weiss H, Weiss M, Zorron R, Bouvy ND. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 2019; 33:996-1019. [PMID: 30771069 PMCID: PMC6430755 DOI: 10.1007/s00464-019-06693-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
Background Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. Methods An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. Results In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. Conclusions Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yannick M Meyer
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Stavros A Antoniou
- Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Isaías Alarcón Del Agua
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Amir Ben Yehuda
- Surgery division, Assaf Harofe medical center, Zeriffin, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tao Yang
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Sofie Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
| | | | | | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Marco Migliore
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | | | - Antonio Morandeira-Rivas
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Carlos Moreno-Sanz
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Eran Nizri
- Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Myrthe Nuijts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonas Raakow
- Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Helmut Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Michael Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Ricardo Zorron
- Department of Surgery, University of Insubria, Varese, Italy
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Ece I, Ozturk B, Yilmaz H, Yormaz S, Şahin M. The effect of single incision laparoscopic cholecystectomy on systemic oxidative stress: a prospective clinical trial. Ann Surg Treat Res 2017; 92:179-183. [PMID: 28382289 PMCID: PMC5378557 DOI: 10.4174/astr.2017.92.4.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) has become a more frequently performed method for benign gallbladder diseases all over the world. The effects of SILC technique on oxidative stress have not been well documented. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy techniques on systemic oxidative stress by using ischemia modified albumin (IMA). Methods In total, 70 patients who had been diagnosed with benign gallbladder pathology were enrolled for this prospective study. Twenty-one patients underwent SILC and 49 patients underwent laparoscopic cholecystectomy (LC). All operations were performed under a standard anesthesia protocol. Serum IMA levels were analysed before operation, 45 minutes and 24 hours after operation. Results Demographics and preoperative characteristics of the patients were similiar in each group. The mean duration of operation was 37.5 ± 12.5 and 44.6 ± 14.3 minutes in LC and SILC group, respectively. In both groups, there was no statistically significant difference in hospital stay, operative time, or conversion to open surgery. Operative technique did not effect the 45th minute and 24th hour IMA levels. However, prolonged operative time (>30 minutes) caused an early increase in the level of IMA. Twenty-fourth hour IMA levels were not different. Conclusion SILC is an effective and safe surgical prosedure for benign gallbladder diseases. Independent of the surgical technique for cholecystectomy, the prolonged operative time could increase the tissue ischemia.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Bahadir Ozturk
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Şahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
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Ece I, Yilmaz H, Yormaz S, Sahin M. Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair. J Minim Access Surg 2017; 13:37-41. [PMID: 27251835 PMCID: PMC5206837 DOI: 10.4103/0972-9941.181394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: Laparoscopic surgery has been a frequently performed method for inguinal hernia repair. Studies have demonstrated that the laparoscopic transabdominal preperitoneal (TAPP) approach is an appropriate choice for inguinal hernia repair. Single-incision laparoscopic surgery (SILS) was developed to improve the cosmetic effects of conventional laparoscopy. The aim of this study was to evaluate the safety and feasibility of SILS-TAPP compared with TAPP technique. MATERIALS AND METHODS: A total of 148 patients who underwent TAPP or SILS-TAPP in our surgery clinic between December 2012 and January 2015 were enrolled. Data including patient demographics, hernia characteristics, operative time, intraoperative and postoperative complications, length of hospital stay and recurrence rate were retrospectively collected. RESULTS: In total, 60 SILS-TAPP and 88 TAPP procedures were performed in the study period. The two groups were similar in terms of gender, type of hernia, and American Society of Anesthesiologists (ASA) classification score. The patients in the SILS-TAPP group were younger when compared the TAPP group. Port site hernia (PSH) rate was significantly high in the SILS-TAPP group, and all PSHs were recorded in patients with severe comorbidities. The mean operative time has no significant difference in two groups. All SILS procedures were completed successfully without conversion to conventional laparoscopy or open repair. No intraoperative complication was recorded. There was no recurrence during the mean follow-up period of 15.2 ± 3.8 months. CONCLUSION: SILS TAPP for inguinal hernia repair seems to be a feasible, safe method, and is comparable with TAPP technique. However, randomized trials are required to evaluate long-term clinical outcomes.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Selcuk University, Konya, Turkey
| | | | - Serdar Yormaz
- Department of Surgery, Selcuk University, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Selcuk University, Konya, Turkey
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Homma S, Kawamata F, Shibasaki S, Kawamura H, Takahashi N, Taketomi A. Does reduced-port laparoscopic surgery for medically uncontrolled ulcerative colitis do more harm than good? Asian J Endosc Surg 2016; 9:24-31. [PMID: 26490730 DOI: 10.1111/ases.12250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/02/2015] [Accepted: 09/10/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Reduced-port laparoscopic surgery is a novel minimally invasive surgery. However, reduced-port surgery for ulcerative colitis (UC) remains controversial. Here, we describe the clinical outcomes of single-incision plus one port laparoscopic surgery (SILS + 1) for medically uncontrolled UC. METHODS Between May 2011 and September 2014, 10 UC patients underwent SILS + 1 port surgery. All procedures were performed with the use of a SILS port and either a 5-mm or a 12-mm port placed at the planned ileostomy site. RESULTS The median age of patients was 32 years (range, 22-53 years). Six patients underwent two-stage SILS + 1 port restorative proctocolectomy with ileal pouch-anal anastomosis, two patients underwent SILS + 1 total proctocolectomy, and the remaining two patients underwent SILS + 1 subtotal colectomy with subsequent three-stage SILS + 1 ileal pouch-anal anastomosis. The median operative time was 363.1 min (range, 253-465 min) and the median estimated blood loss was 29 mL (range, 0-100 mL). There were no conversions or additional ports required. Two patients previously underwent SILS + 1 subtotal colectomy, and in one of those patients, SILS + 1 ileal pouch-anal anastomosis was performed successfully 6 months after the previous surgery. There were no intra-abdominal adhesions, and no extra wounds were necessary because the previous stoma site had been used to access the SILS port. The median postoperative period was 24 months, during which five patients had their ileostomies closed. No patients reported occasional minor daily soiling or the need to wear a pad. CONCLUSION Reduced-port laparoscopic surgery for medically uncontrolled UC is a feasible and safe procedure when performed by skilled surgeons.
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Affiliation(s)
- Shigenori Homma
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Futoshi Kawamata
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Shibasaki
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideki Kawamura
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Norihiko Takahashi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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