Abstract
Background
Single-port laparoscopic surgery (SILS) is a new minimally invasive technique, which has been developed to minimize the surgical access trauma. For colorectal resection, the access trauma can be limited to the one incision, which is needed for specimen extraction anyways, but dissection might be more demanding than in multiport laparoscopic surgery. The aim of this study was to evaluate the usefulness of SILS for the treatment of diverticular disease of the sigmoid colon.
Methods
Between July 2009 and December 2013, a total of 329 consecutive patients with intended SILS sigmoid colectomy for complicated or frequently recurring diverticulitis were studied. Clinical data were collected in a prospective database. Telephone follow-ups were performed to evaluate long-term morbidity and quality of life.
Results
Of the 329 patients (139 male) with intended SILS sigmoid colectomy, 309 were successfully operated on in SILS technique, while 20 (6.1 %) were converted to open surgery. The mean duration of surgery was 153.5 (65–434) min. Total morbidity rate was 18.3 %. Anastomotic leakage was the most serious complication occurring in 13 patients (leak rate 4 %) with one consecutive death (mortality rate 0.3 %). Quality of life had significantly improved 6 months after surgery in comparison with the preoperative value. At a mean follow-up of 18.6 months, 16 patients (4.9 %) had incisional hernia and one patient had recurrent diverticulitis.
Conclusion
In spite of almost 5 % incisional hernia 6 months after surgery, single-incision sigmoid colectomy for diverticulitis is feasible and save and is therefore an alternative to multiport laparoscopic surgery. Further trials are necessary to evaluate its benefits over multiport laparoscopic surgery.
Similar content being viewed by others
References
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1(3):144–150
Franklin ME Jr, Ramos R, Rosenthal D, Schuessler W (1993) Laparoscopic colonic procedures. World J Surg 17(1):51–56
Sammour T, Kahokehr A, Srinivasa S, Bissett IP, Hill AG (2011) Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 253(1):35–43
Stassen LP, Bemelman WA, Meijerink J (2010) Risks of minimally invasive surgery underestimated: a report of the Dutch Health Care Inspectorate. Surg Endosc 24(3):495–498
Franklin ME Jr, Rosenthal D, Norem RF (1995) Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma. A multicenter study. Surg Endosc 9(7):811–816
Bartels SA, Vlug MS, Ubbink DT, Bemelman WA (2010) Quality of life after laparoscopic and open colorectal surgery: a systematic review. World J Gastroenterol WJG 16(40):5035–5041
Pendlimari R, Touzios JG, Azodo IA, Chua HK, Dozois EJ, Cima RR et al (2011) Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 98(3):431–435
Huang MJ, Liang JL, Wang H, Kang L, Deng YH, Wang JP (2011) Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 26(4):415–421
Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK (2010) Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg 200(1):144–161
Stevenson AR, Stitz RW, Lumley JW, Fielding GA (1998) Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 227(3):335–342
Jones OM, Stevenson AR, Clark D, Stitz RW, Lumley JW (2008) Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg 248(6):1092–1097
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES et al (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the sigma trial. Ann Surg 249(1):39–44
Klarenbeek BR, Bergamaschi R, Veenhof AA, van der Peet DL, van den Broek WT, de Lange ES et al (2011) Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial. Surg Endosc 25(4):1121–1126
Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252(1):3–8
Rink AD, John-Enzenauer K, Haaf F, Straub E, Nagelschmidt M, Vestweber KH (2009) Laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy for diverticular disease? A prospective randomized trial on postoperative pain and analgesic consumption. Dis Colon Rectum 52(10):1738–1745
Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11(10):1021–1025
Saad S, Hosogi H (2011) Laparoscopic left colectomy combined with natural orifice access: operative technique and initial results. Surg Endosc 25(8):2742–2747
Wilson JI, Dogiparthi KK, Hebblethwaite N, Clarke MD (2007) Laparoscopic right hemicolectomy with posterior colpotomy for transvaginal specimen retrieval. Colorectal Disease Off J Assoc Coloproctol G B Irel 9(7):662
Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84(5):695
Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247(4):583–602
Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23(10):1013–1016
Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis Off J Assoc Coloproctol G B Irel 10(8):823–826
Vestweber B, Alfes A, Paul C, Haaf F, Vestweber KH (2010) Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc 24(12):3225–3228
Vestweber B, Galetin T, Lammerting K, Paul C, Giehl J, Straub E et al (2013) Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surg Endosc 27(2):434–442
Wolff BG, Boostrom SY (2012) Prophylactic resection, uncomplicated diverticulitis, and recurrent diverticulitis. Dig Dis 30(1):108–113
Horgan AF, McConnell EJ, Wolff BG, The S, Paterson C (2001) Atypical diverticular disease: surgical results. Dis Colon Rectum 44(9):1315–1318
Hansen O, Stock, W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons—Stufenkonzept durch exaktes Stadieneinteilung. Langenbecks Arch Chir (Suppl 2): 1257–1260
Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E et al (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82(2):216–222
Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H (1993) Der Gastrointestinale Lebensqualitatsindex (GLQI). Ein klinimetrischer Index zur Befindlichkeitsmessung in der gastroenterologischen Chirurgie [The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 64(4):264–274
Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147(8):724–731
Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294
Weiss HG, Brunner W, Biebl MO, Schirnhofer J, Pimpl K, Mittermair C et al (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259(1):89–95
Fung AK, Aly EH (2012) Systematic review of single-incision laparoscopic colonic surgery. Br J Surg 99(10):1353–1364
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. doi:10.1002/14651858.CD003145.pub2
Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB et al (2012) Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc 26(1):96–102
Wolthuis AM, Penninckx F, Fieuws S, D’Hoore A (2012) Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Colorectal Dis Off J Assoc Coloproctol G B Irel 14(5):634–641
Lu CC, Lin SE, Chung KC, Rau KM (2012) Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal Dis Off J Assoc Coloproctol G B Irel 14(4):e171–e176
Waters JA, Guzman MJ, Fajardo AD, Selzer DJ, Wiebke EA, Robb BW et al (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53(11):1467–1472
Adair J, Gromski MA, Lim RB, Nagle D (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum 53(11):1549–1554
Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C et al (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25(6):1887–1892
Papaconstantinou HT, Sharp N, Thomas JS (2011) Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg 213(1):72–80 discussion -2
Vasilakis V, Clark CE, Liasis L, Papaconstantinou HT (2013) Noncosmetic benefits of single-incision laparoscopic sigmoid colectomy for diverticular disease: a case-matched comparison with multiport laparoscopic technique. J Surg Res 180(2):201–207
Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54(2):183–186
Gandhi DP, Ragupathi M, Patel CB, Ramos-Valadez DI, Pickron TB, Haas EM (2010) Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series. J Gastrointest Surg Off J Soc Surg Aliment Tract 14(12):1875–1880
Fichera A, Zoccali M, Gullo R (2011) Single incision (“scarless”) laparoscopic total abdominal colectomy with end ileostomy for ulcerative colitis. J Gastrointest Surg Off J Soc Surg Aliment Tract 15(7):1247–1251
Park SJ, Lee KY, Kang BM, Choi SI, Lee SH (2013) Initial experience of single-port laparoscopic surgery for sigmoid colon cancer. World J Surg 37(3):652–656
Raue W, Paolucci V, Asperger W, Albrecht R, Buchler MW, Schwenk W (2011) Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie 396(7):973–980
Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbecks Arch Surg/Deutsche Gesellschaft fur Chirurgie 389(2):97–103
Kockerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J et al (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13(6):567–571
Mbadiwe T, Obirieze AC, Cornwell EE III, Turner P, Fullum TM (2013) Surgical management of complicated diverticulitis: a comparison of the laparoscopic and open approaches. J Am Coll Surg 216(4):782–788 discussion 8-90
Erdas E, Zedda A, Pitzalis A, Scano D, Barbarossa M, Aresu S et al (2009) La deiscenza anastomotica in chirurgia colorettale: incidenza, fattori di rischio e trattamnento [Anastomotic leak following colorectal surgery: incidence, risk factors and treatment]. Chir Ital 61(4):407–417
Levack M, Berger D, Sylla P, Rattner D, Bordeianou L (2011) Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis. Arch Surg 146(2):207–210
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270
Cirocchi R, Trastulli S, Farinella E, Desiderio J, Listorti C, Parisi A et al (2012) Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials. Colorectal Dis Off J Assoc Coloproctol G B Irel 14(9):e521–e529
Masoomi H, Buchberg B, Nguyen B, Tung V, Stamos MJ, Mills S (2011) Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis. World J Surg 35(9):2143–2148
Gaertner WB, Kwaan MR, Madoff RD, Willis D, Belzer GE, Rothenberger DA et al (2013) The evolving role of laparoscopy in colonic diverticular disease: a systematic review. World J Surg 37(3):629–638
Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M et al (2012) High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 26(11):3180–3185
DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2011) Incisional hernia, midline versus low transverse incision: What is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 25(4):1031–1036
Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A et al (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54
Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS ONE 8(10):e76530
Saad S, Strassel V, Sauerland S (2013) Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 100(3):339–349
Markar SR, Karthikesalingam A, Di Franco F, Harris AM (2013) Systematic review and meta-analysis of single-incision versus conventional multiport appendicectomy. Br J Surg 100(13):1709–1718
Bencsath KP, Falk G, Morris-Stiff G, Kroh M, Walsh RM, Chalikonda S (2012) Single-incision laparoscopic cholecystectomy: Do patients care? J Gastrointest Surg Off J Soc Surg Aliment Tract 16(3):535–539
Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2015) Transvaginal/transumbilical hybrid-NOTES-versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg 261(3):451–458
Disclosures
Boris Vestweber has received traveling support and honoraria from Covidien for teaching single-port laparoscopic surgery and introducing this technique in other hospitals. Andreas D. Rink, Claudia Paul and Karl-Heinz Vestweber have not received any financial support over the last 3 years and have therefore no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vestweber, B., Vestweber, KH., Paul, C. et al. Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients. Surg Endosc 30, 50–58 (2016). https://doi.org/10.1007/s00464-015-4160-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4160-7