Colorectal Surgery

Abstract

Since a case series on laparoscopic colectomy was firstly published in 1991 (Jacobs et al., Surg Laparosc Endosc 1:144–150, 1991), various randomized controlled trials (RCTs), non-RCTs and other types of studies had been performed, focusing on the evaluation of feasibility and safety of laparoscopic colorectal surgeries. Several meta-analyses and systematic reviews basing on RCTs and non-RCTs related to the comparison of laparoscopic and laparotomic colorectal surgeries have been established, finding out that laparoscopic surgery for colorectal cancer was non-inferior to laparotomy in terms of overall survival (Martel et al., PLoS One 7:e35292, 2012), short-term and long-term of oncological outcomes (Huang et al., Int J Colorectal Dis 26:415–421, 2011; Ma et al., Med Oncol 28:925–933, 2011), and also with shorter post-operative hospital stay (Lourenco et al., Surg Endosc 22:1146–1160, 2008). No significant differences were identified in the occurrence of major surgical complications but were associated with lower overall morbidity and minor complication rate in the management of diverticulitis (Siddiqui et al., Am J Surg 200:144–161, 2010; Cirocchi et al., Colorectal Dis 14:671–683, 2012) in the laparoscopic groups.

Substantially, laparoendoscopic single-site colorectal surgery (SILSC) is an evaluation of traditional multiport laparoscopic colorectal surgery (MLC), offering the minimally invasive advantages and cosmetic advantages over MLC with a single incision typically hidden in the umbilicus (Lu et al., Colorectal Dis 14:e171–e176, 2012). It has been applied to several colorectal procedures successfully, including right hemicolectomy, total colectomy, proctocolectomy with ileal pouch anal anastomosis, and left colectomy (Lu et al., Colorectal Dis 14:e171–e176, 2012; Chen et al., Surg Endosc 25:1887–1892, 2011; Kim et al., Ann Surg 254:933–940, 2011; Lai et al., Colorectal Dis 14:1138–1144, 2012; Papaconstantinou and Thomas, Surgery 150:820–827, 2011; Fujii et al., Surg Endosc 26:1403–1411, 2012; Poon et al., Surg Endosc 26:2729–2734, 2012; Ramos-Valadez et al., Surg Endosc 26:96–102, 2012; Rijcken et al., Dis Colon Rectum 55:140–146, 2012; Huscher et al., Am J Surg 204:115–120, 2012; Lee et al., Dis Colon Rectum 54:1355–1361, 2011; Waters et al., Dis Colon Rectum 53:1467–1472, 2010; Champagne et al., Dis Colon Rectum 54:183–186, 2011; Champagne et al., Ann Surg 255:66–69, 2012; Adair et al., Dis Colon Rectum 53:1549–1554, 2010; Gaujoux et al., J Gastrointest Surg 16:629–634, 2012; Kanakala et al., Tech Coloproctol 16:423–428, 2012; McNally et al., Surg Endosc 25:3559–3565, 2011; Wolthuis et al., Colorectal Dis 14:634–641, 2012; Papaconstantinou et al., J Am Coll Surg 213:72–80, 2011). A deceased post-operative pain score was reported, which might be due to the reduced number of lateral ports, thus decreasing post-operative discomfort (Champagne et al., Dis Colon Rectum 54:183–186, 2011; Chambers et al., Colorectal Dis 13:393–398, 2011). Additionally, the lower cost (McNally et al., Surg Endosc 25:3559–3565, 2011; Chambers et al., Colorectal Dis 13:393–398, 2011), faster recovery (Chambers et al., Colorectal Dis 13:393–398, 2011), decreased length of the largest incision (Lu et al., Colorectal Dis 14:e171–e176, 2012; Fujii et al., Surg Endosc 26:1403–1411, 2012; Lee et al., Dis Colon Rectum 54:1355–1361, 2011; Zhou et al., Dig Dis Sci 57:2103–2112, 2012), and diminished risk of incisional hernias (Ramos-Valadez et al., Surg Endosc 26:96–102, 2012) were also reviewed.

Though no criteria of contraindications for SILSC has been created, emergent condition, T4 tumors, history of abdominal surgery, morbid obesity, poor American Society of Anesthesiologists class or large size of malignant disease may act as risk factors for the performance of SILSC (Chen et al., Surg Endosc 25:1887–1892, 2011; Kim et al., Ann Surg 254:933–940, 2011; Ramos-Valadez et al., Surg Endosc 26:96–102, 2012; Huscher et al., Am J Surg 204:115–120, 2012; Waters et al., Dis Colon Rectum 53:1467–1472, 2010).

Though with potentially higher overall conversion rate, SILSC may be more feasible and safe in experienced hands if the patients are carefully selected, especially for malignancies. SILSC will benefit the patients more with its superiority over MLC.