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Single-incision-Laparoskopie

Statusanalyse

Single incision laparoscopy

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Zusammenfassung

Hintergrund

Seit Einführung der Single-incision-Laparoskopie (SIL) besteht Uneinigkeit innerhalb der Fachgesellschaften zur generellen Empfehlung einer Anwendung dieser minimalinvasiven Methode.

Fragestellung

Prüfung der wissenschaftlichen Evidenz in der Darstellung verbesserter Ergebnisse im Vergleich zur Multi-port-Laparoskopie (MPL).

Material und Methoden

Beschreibung der aktuellen technischen Entwicklung mit Auswertung der rezenten prospektiv randomisierten Studien und methodisch hochwertigen Metaanalysen bezogen auf verschiedene Organbereiche. Diskussion der eigenen Erfahrungen anhand von 4209 SIL-Eingriffen.

Ergebnisse

Die SIL findet in allen Bereichen der Allgemein- und Viszeralchirurgie Anwendung. Im Zuge der großen Euphorie der ersten Jahre wurden vielfach methodisch schwache Studien publiziert. Der generelle Beweis einer signifikanten Verbesserung der Morbidität ist wissenschaftlich nicht erbracht. Die Verbesserung des kosmetischen Ergebnisses ist entweder offenkundig (SIL-Leberresektionen) oder aber nicht klar belegbar (SIL-Cholezystektomien).

Diskussion

Nach überwundener Lernkurve erweist sich die SIL als sicher und machbar. Die wissenschaftliche Evidenz erlaubt keine Pro- oder Kontra-Stellungnahme ohne Berücksichtigung der individuellen chirurgischen Expertise.

Abstract

Background

Since the introduction of single incision laparoscopy (SIL), there has been disagreement among professional societies regarding a general recommendation for the use of this minimally invasive method.

Objectives

Determination of evidence-based advantages of SIL compared to multiport laparoscopy (MPL).

Materials and methods

Description of recent technical developments and evaluation of prospective randomized clinical trials and valid meta-analyses with regard to organ-specific procedures. In addition, an expert opinion is provided based on 4209 SIL interventions.

Results

SIL is nowadays applied in all fields of general and visceral surgery. Due to the initial enthusiasm, methodologically weak studies were often published in the literature. Any beneficial effect of SIL on reduced perioperative morbidity is not clearly confirmed, yet. A better cosmetic outcome is either obvious (in SIL liver resections) or nearly unverifiable (in SIL cholecystectomies).

Conclusion

SIL has proven feasible and safe after getting through the learning curve. Scientific evidence is currently insufficient to justify SIL without reservation in particular without the individual technical experience of the surgeon.

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Literatur

  1. Brockhaus AC, Sauerland S, Saad S (2016) Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease: a systematic review, meta-analysis and assessment of the evidence. BMC Surg 18(16):71

    Article  Google Scholar 

  2. Huscher CG, Mingoli A, Sgarzini G et al (2012) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204:115–120

    Article  PubMed  Google Scholar 

  3. Li L, Tian J, Tian H et al (2014) The efficacy and safety of different kinds of laparoscopic cholecystectomy: a network meta analysis of 43 randomized controlled trials. PLOS ONE 9(2):e90313

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lo CW, Yang SS, Tsai YC et al (2016) Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia 20:21–32

    Article  PubMed  Google Scholar 

  5. Luo S, Wu S, Lai H et al (2017) Single-incision laparoscopic inguinal hernioplasty versus conventional laparoscopic inguinal hernioplasty. Surg Innov 24:171–182

    Article  PubMed  Google Scholar 

  6. Marcus HJ, Seneci CA, Hughes-Hallett A et al (2016) Comparative performance in single-port versus multiport minimally invasive surgery, and small versus large operative working spaces: a preclinical randomized crossover trial. Surg Innov 23:148–155

    Article  PubMed  Google Scholar 

  7. Miernik A, Schoenthaler M, Lilienthal K et al (2012) Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery: comparative study of performance in a dry lab. Surg Endosc 26:1924–1930

    Article  PubMed  Google Scholar 

  8. Navarra G, Pozza E, Occhionorelli S et al (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    Article  CAS  PubMed  Google Scholar 

  9. Pelosi MA, Pelosi MA 3rd (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594

    CAS  PubMed  Google Scholar 

  10. Poon JT, Cheung CW, Fan JK et al (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734

    Article  PubMed  Google Scholar 

  11. Qadan M, Curet MJ, Wren SMJ (2014) The evolving application of single-port robotic surgery in general surgery. J Hepatobiliary Pancreat Sci 21:26–33

    Article  PubMed  Google Scholar 

  12. Schill MR, Varela JE, Frisella MM, Brunt LM (2012) Comparison of laparoscopic skills performance between single-site access (SSA) devices and an independent-port SSA approach. Surg Endosc 26:714–721

    Article  PubMed  Google Scholar 

  13. Wang L, Wu Z, Li M (2013) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 27:743–750

    Article  PubMed  Google Scholar 

  14. Wang YB, Xia J, Zhang JY et al (2017) Effectiveness and safety of single-port versus multi-port laparoscopic surgery for treating liver diseases: a meta-analysis. Surg Endosc 31:1524–1537

    Article  PubMed  Google Scholar 

  15. Weiss HG, Brunner W, Biebl MO et al (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259:89–95

    Article  PubMed  Google Scholar 

  16. Weiss H, Zorron R, Vestweber KH et al (2017) ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures. Br J Surg 104:128–137

    Article  CAS  PubMed  Google Scholar 

  17. Weiss M, Mittermair C, Brunner E et al (2015) Inline radiofrequency pre-coagulation simplifies single-incision laparoscopic minor liver resection. J Hepatobiliary Pancreat Sci 22:831–836

    Article  PubMed  Google Scholar 

  18. Wu S, Lai H, Zhao (2016) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: an updated meta analysis. J Urol 13:2590–2598

    Google Scholar 

  19. Yamazaki M, Yasuda H, Koda K (2015) Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today 45:537–548

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Chirurgie, A. ö. Krankenhaus der Barmherzigen Brüder, Kajetanerplatz 1, 5010, Salzburg, Österreich

    H. Weiss, C. Mittermair & M. Weiss

  2. Lehrabteilung, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Österreich

    H. Weiss, C. Mittermair & M. Weiss

  3. Lehrabteilung, Medizinische Universität Innsbruck (MUI), Innsbruck, Österreich

    H. Weiss, C. Mittermair & M. Weiss

  4. Lehrabteilung, Medizinische Universität Wien (MUW), Wien, Österreich

    H. Weiss, C. Mittermair & M. Weiss

Authors
  1. H. Weiss
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  2. C. Mittermair
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  3. M. Weiss
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Corresponding author

Correspondence to H. Weiss.

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Interessenkonflikt

H. Weiss, C. Mittermair und M. Weiss geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen (oder Tieren) außerhalb der Deklaration von Helsinki (WHO) zu Ethischen Grundsätzen für die medizinische Forschung.

Caption Electronic Supplementary Material

Zusätzliches Video: nichtanatomische Metastasenresektion in Segment VII in SIL-Technik

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Weiss, H., Mittermair, C. & Weiss, M. Single-incision-Laparoskopie. Chirurg 88, 669–674 (2017). https://doi.org/10.1007/s00104-017-0446-8

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  • DOI: https://doi.org/10.1007/s00104-017-0446-8

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