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Surgical Endoscopy

, Volume 26, Issue 1, pp 96–102 | Cite as

Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series

  • Diego I. Ramos-Valadez
  • Madhu Ragupathi
  • Javier Nieto
  • Chirag B. Patel
  • Steven Miller
  • T. Bartley Pickron
  • Eric M. HaasEmail author
Article

Abstract

Background

Single-incision laparoscopic surgery is an emerging modality that has proven to be safe and feasible for colon resection in multiple case reports and series. Nonetheless, comparative analyses with established techniques are limited in the published literature. We evaluated the efficacy of single-incision laparoscopic colectomy (SILC) for the treatment of sigmoid disease through a matched-case comparison with conventional laparoscopic colectomy (CLC).

Methods

Twenty patients who underwent single-incision laparoscopic sigmoid resection for benign or malignant disease between July 2009 and September 2010 were matched to patients who underwent conventional laparoscopic sigmoid colectomy. Demographic, intraoperative, and postoperative data were assessed.

Results

Twenty SILC and CLC cases each were paired based on gender (p < 1.0), age (p < 0.47), pathology (p < 1.0), and surgical procedure (p < 1.0). Ten patients (50%) in the SILC group and eight patients (40%) in the CLC group had a history of prior abdominal surgery (p < 0.53). There were no conversions to open surgery; however, one SILC procedure (5%) required conversion to CLC (p < 0.31). There was no significant difference in mean operating time between groups (p < 0.80). Mean estimated blood loss was significantly lower for SILC compared to CLC (p < 0.007). Mean lymph node extraction was comparable between groups in the subset of patients with malignant disease (p < 0.68). Two postoperative complications were encountered in each group. The mean length of hospital stay for SILC and CLC was 3.2 ± 1.0 and 3.8 ± 2.1 days, respectively (p < 0.25). There were no readmissions or reoperative interventions in either group.

Conclusion

Compared with conventional laparoscopic technique, single-incision laparoscopic surgery results in similar intraoperative and postoperative outcomes. The technique avoids use of multiple trocar sites and may safely be performed in patients with a history of previous abdominal surgery while maintaining a short length of hospital stay and low complication rate.

Keywords

Single-incision laparoscopic surgery Sigmoid resection Colectomy Colon cancer Colorectal surgery Minimally invasive surgery 

Notes

Disclosure

Dr. Pickron is a preceptor for Applied Medical (Rancho Santa Margarita, CA, USA) and Ethicon Endo-Surgery (Cincinnati, OH, USA). Dr. Haas is a preceptor for Applied Medical (Rancho Santa Margarita, CA, USA). Drs. Ramos-Valadez, Ragupathi, Nieto, Patel, and Miller have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016PubMedCrossRefGoogle Scholar
  2. 2.
    Rieger NA, Lam FF (2009) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24:888–890PubMedCrossRefGoogle Scholar
  3. 3.
    Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H (2010) Single incision laparoscopic sigmoid colon resection without visible scar: a novel technique. Colorectal Dis 12:66–70PubMedCrossRefGoogle Scholar
  4. 4.
    Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826PubMedCrossRefGoogle Scholar
  5. 5.
    Chambers W, Bicsak M, Lamparelli M, Dixon A (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398PubMedCrossRefGoogle Scholar
  6. 6.
    Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM (2010) Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc 24:2613–2616PubMedCrossRefGoogle Scholar
  7. 7.
    Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52:1797–1801PubMedCrossRefGoogle Scholar
  8. 8.
    Boni L, Dionigi G, Cassinotti E, Di Giuseppe M, Diurni M, Rausei S, Cantore F, Dionigi R (2010) Single incision laparoscopic right colectomy. Surg Endosc 24:3233–3236PubMedCrossRefGoogle Scholar
  9. 9.
    Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024PubMedCrossRefGoogle Scholar
  10. 10.
    Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2010) Single incision laparoscopic-assisted right hemicolectomy: technique and application (with video). Surg Laparosc Endosc Percutan Tech 20:e146–e149PubMedCrossRefGoogle Scholar
  11. 11.
    Uematsu D, Akiyama G, Magishi A, Nakamura J, Hotta K (2010) Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction. Dis Colon Rectum 53:944–948PubMedCrossRefGoogle Scholar
  12. 12.
    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 53:1549–1554PubMedCrossRefGoogle Scholar
  13. 13.
    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 14:1875–1880PubMedCrossRefGoogle Scholar
  14. 14.
    Waters JA, Guzman MJ, Fajardo AD, Selzer DJ, Wiebke EA, Robb BW, George VV (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53:1467–1472PubMedCrossRefGoogle Scholar
  15. 15.
    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 54:183–186PubMedCrossRefGoogle Scholar
  16. 16.
    Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, Ke TW (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25(6):1887–1892PubMedCrossRefGoogle Scholar
  17. 17.
    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):72–80PubMedCrossRefGoogle Scholar
  18. 18.
    Ramos-Valadez DI, Patel CB, Ragupathi M, Bokhari MB, Pickron TB, Haas EM (2011) Single-incision laparoscopic colectomy: outcomes of an emerging minimally invasive technique. Int J Colorectal Dis 26(6):761–767PubMedCrossRefGoogle Scholar
  19. 19.
    Ragupathi M, Ramos-Valadez DI, Yaakovian MD, Haas EM (2011) Single-incision laparoscopic colectomy: a novel approach through a Pfannenstiel incision. Tech Coloproctol 15:61–65PubMedCrossRefGoogle Scholar
  20. 20.
    Keshava A, Young CJ, Mackenzie S (2010) Single-incision laparoscopic right hemicolectomy. Br J Surg 97:1881–1883PubMedCrossRefGoogle Scholar
  21. 21.
    Pietrasanta D, Romano N, Prosperi V, Lorenzetti L, Basili G, Goletti O (2010) Single-incision laparoscopic right colectomy for cancer: a single-centre preliminary experience. Updates Surg 62:111–115PubMedCrossRefGoogle Scholar
  22. 22.
    Wong MT, Ng KH, Ho KS, Eu KW (2010) Single-incision laparoscopic surgery for right hemicolectomy: our initial experience with 10 cases. Tech Coloproctol 14:225–228PubMedCrossRefGoogle Scholar
  23. 23.
    Keshava A, Mackenzie S, Al-Kubati W (2010) Single-port laparoscopic right colonic resection. ANZ J Surg 80:30–32PubMedCrossRefGoogle Scholar
  24. 24.
    Choi SI, Lee KY, Park SJ, Lee SH (2010) Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer. World J Gastroenterol 16:275–278PubMedCrossRefGoogle Scholar
  25. 25.
    Law WL, Fan JK, Poon JT (2010) Single-incision laparoscopic colectomy: early experience. Dis Colon Rectum 53:284–288PubMedCrossRefGoogle Scholar
  26. 26.
    Bardakcioglu O, Ahmed S (2010) Single incision laparoscopic total abdominal colectomy with ileorectal anastomosis for synchronous colon cancer. Tech Coloproctol 14:257–261PubMedCrossRefGoogle Scholar
  27. 27.
    Cahill RA, Lindsey I, Jones O, Guy R, Mortensen N, Cunningham C (2010) Single-port laparoscopic total colectomy for medically uncontrolled colitis. Dis Colon Rectum 53:1143–1147PubMedCrossRefGoogle Scholar
  28. 28.
    Leblanc F, Makhija R, Champagne BJ, Delaney CP (2011) Single incision laparoscopic total colectomy and proctocolectomy for benign disease—initial experience. Colorectal Dis. doi: 10.1111/j.1463-1318.2010.02448.x
  29. 29.
    Geisler DP, Condon ET, Remzi FH (2010) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12:941–943PubMedCrossRefGoogle Scholar
  30. 30.
    Law WL, Fan JK, Poon JT (2010) Single incision laparoscopic left colectomy for carcinoma of distal transverse colon. Colorectal Dis 12:698–701PubMedCrossRefGoogle Scholar
  31. 31.
    Bucher P, Pugin F, Morel P (2010) Transumbilical single incision laparoscopic sigmoidectomy for benign disease. Colorectal Dis 12:61–65PubMedCrossRefGoogle Scholar
  32. 32.
    Ishida H, Okada N, Ishibashi K, Ohsawa T, Kumamoto K, Haga N (2011) Single-incision laparoscopic-assisted surgery for colon cancer via a periumbilical approach using a surgical glove: Initial experience with 9 cases. Int J Surg 9:150–154PubMedCrossRefGoogle Scholar
  33. 33.
    Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179PubMedCrossRefGoogle Scholar
  34. 34.
    Podolsky ER, Curcillo PG 2nd (2010) Single port access (SPA) surgery—a 24-month experience. J Gastrointest Surg 14:759–767PubMedCrossRefGoogle Scholar
  35. 35.
    Remzi FH, Kirat HT, Geisler DP (2010) Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol 14:253–255PubMedCrossRefGoogle Scholar
  36. 36.
    Takemasa I, Sekimoto M, Ikeda M, Mizushima T, Yamamoto H, Doki Y, Mori M (2010) Video. Transumbilical single-incision laparoscopic surgery for sigmoid colon cancer. Surg Endosc 24:2321PubMedCrossRefGoogle Scholar
  37. 37.
    Uematsu D, Akiyama G, Matsuura M, Hotta K (2010) Single-access laparoscopic colectomy with a novel multiport device in sigmoid colectomy for colon cancer. Dis Colon Rectum 53:496–501PubMedCrossRefGoogle Scholar
  38. 38.
    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 24:3225–3228PubMedCrossRefGoogle Scholar
  39. 39.
    Hashizume M, Sugimachi K (1997) Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc 11:1198–1201PubMedCrossRefGoogle Scholar
  40. 40.
    Helgstrand F, Rosenberg J, Bisgaard T (2011) Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15:113–121PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Diego I. Ramos-Valadez
    • 1
  • Madhu Ragupathi
    • 1
  • Javier Nieto
    • 1
  • Chirag B. Patel
    • 1
  • Steven Miller
    • 1
  • T. Bartley Pickron
    • 1
  • Eric M. Haas
    • 1
    Email author
  1. 1.Division of Minimally Invasive Colon and Rectal Surgery, Department of SurgeryUniversity of Texas Medical School at HoustonHoustonUSA

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