Short-Term Outcomes of Single-Incision Versus Conventional Laparoscopic Surgery for Colorectal Diseases: Meta-Analysis of Randomized and Prospective Evidence
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Conventional laparoscopic surgery (CLS) has been established as an alternative to open surgery for colorectal diseases (CRDs); simultaneously, single-incision laparoscopic surgery (SILS) is gaining popularity.
The aim of this study was to compare the short-term efficacy and safety of SILS with CLS for CRDs.
MEDLINE, EMBASE, and the Cochrane Library were searched for relevant randomized and prospective studies. Reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases were also screened. Outcome measures included surgical parameters, postsurgical recovery, pain, and adverse events. Meta-analysis was conducted where appropriate, comparing items using weighted mean differences (WMDs) and risk ratios (RRs) according to data type.
A total of nine prospective (three randomized and six non-randomized) researches published from 2011 to 2015 were identified. The overall pooled results showed compared to CLS, SILS was associated with fewer blood transfusions, shorter incision length, and slighter postoperative pain, but more extra ports. All the other parameters were comparable. Randomized evidence supported SILS was associated with less blood loss, and shorter hospital stay, but longer operative time. For only colectomy cases, SILS was associated with more conversions to open surgery. SILS was associated with longer surgical time for Easterners, but not for Westerners. The detected differences were clinically insignificant.
The results based on randomized and prospective evidence provide convincing support for the clinical similarity that SILS is basically as applicable, effective, and safe as CLS when dealing with colorectal lesions, but not for superiority.
KeywordsSingle-incision laparoscopic surgery Conventional laparoscopic surgery Colorectal disease Efficacy Safety
Conventional laparoscopic surgery
Numeric rating scale
Randomized controlled trial
Single-incision laparoscopic surgery
Weighted mean difference
The authors would most sincerely thank the reviewers and editors for critically reviewing this paper and for the constructive and thoughtful comments and suggestions, and the College of Public Hygiene of Sun Yat-sen University for the statistical assistance. This work was supported by the Natural Science Foundation of Guangdong Province (No. 2014A030313131 and No. 2015A030312013), Key Scientific and Technological Projects of Guangdong Province (No. 2014B020228003 and No. 2014B030301041), and Science and Technology Planning Project of Guangzhou (No. 201400000001-3 and No. 158100076). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Conception and design: L.H.J., H.L., L.T.J., S.J., and L.W.; analysis and interpretation of the data: L.H.J., H.L., L.T.J., S.J., and P.L.R.; drafting of the article: L.H.J., H.L., L.T.J., S.J., and L.W.; critical revision of the article for important intellectual content: H.L., P.L.R., and L.W.; final approval of the article: all authors.
- 1.Xu AM, Huang L, Li TJ. Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials. Surgical endoscopy. 2014.Google Scholar
- 12.Maggiori L, Gaujoux S, Tribillon E, Bretagnol F, Panis Y. Single-incision laparoscopy for colorectal resection: a systematic review and meta-analysis of more than a thousand procedures. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012; 14:e643–54.CrossRefGoogle Scholar
- 34.Der Simonian R, Laird N. Meta-Analysis in Clinical Trials Revisited. Contemporary clinical trials. 2015.Google Scholar
- 35.Gandhi DP, Ragupathi M, Patel CB, Ramos-Valadez DI, Pickron TB, Haas EM. Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2010; 14:1875–80.CrossRefGoogle Scholar
- 39.Theophilus M, Platell C, Spilsbury K. Long-term survival following laparoscopic and open colectomy for colon cancer: a meta-analysis of randomized controlled trials. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2014; 16:O75–81.CrossRefGoogle Scholar
- 40.Huang MJ, Liang JL, Wang H, Kang L, Deng YH, Wang JP. 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. International journal of colorectal disease. 2011; 26:415–21.CrossRefPubMedGoogle Scholar
- 41.Vettoretto N, Cirocchi R, Randolph J, Parisi A, Farinella E, Romano G. Single incision laparoscopic right colectomy: a systematic review and meta-analysis. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2014; 16:O123–32.CrossRefGoogle Scholar
- 46.Lu CC, Lin SE, Chung KC, Rau KM. Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012;14:e171–6.CrossRefGoogle Scholar