Abstract
Background
Laparoscopy has rapidly emerged as the preferred surgical approach for a number of different diseases because it allows for a correct diagnosis and proper treatment. However, it is not being applied in a widespread manner for the management of benign or malignant colorectal disease. Its natural evolution seems to be the development of mini-instruments and optics (diameter, ≤5 mm). This study aimed to illustrate retrospectively the results of an initial minilaparoscopic colorectal surgery experience at two different institutions.
Methods
Between January 2001 and December 2006, a total of 517 patients underwent a laparoscopic colon procedure. Among them, 161 (31.1%) underwent surgery with mini-instruments. The primary end point was the feasibility rate for minilaparoscopic colon resection. The secondary end points were safety and the impact of the technique on the duration of laparoscopy.
Results
No conversion to classical laparoscopy and eight cases converted to the open approach were registered. The rate for major complications was 3.1%, whereas the rate for minor complications ranged as high as 11.8%.
Conclusions
Even if limited by its retrospective design, the reported experience shows that minilaparoscopic surgery may be a safe and effective approach to colon pathology. The described features make minilaparoscopy a challenging alternative to laparoscopy for colon disease. If proven to be cost effective without undue risk, as long as adequate training is obtained and proper preparation is observed, minilaparoscopy may become a standard surgical approach for selected patients.
Similar content being viewed by others
References
Alponat A, Cubukcu Anil, Gonullu N, Canturk Z, Ozbay O (2002) Is minisite cholecystectomy less traumatic? Prospective randomized study comparing minisite and conventional laparoscopic cholecystectomy. World J Surg 26:1437–1440
Berci G (1998) Laparoscopic cholecystectomy using fine-caliber instruments: smaller is not necessarily better. Surg Endosc 12:197
Berci G, Rozga J (1999) Miniature laparoscopy: quo vadis? The basic parameters of image relay and display systems. Surg Endosc 13:211–217
Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosemberg J (2002) Microlaparoscopic vs conventional laparoscopic cholecystectomy. Surg Endosc 16:458–464
Bouillot JL, Berthou JC, Champault G, Meyer C, Arnaud JP, Samama G, Collet D, Bressler P, Gainant A, Delaitre B (2002) Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients. Surg Endosc 16:1320–1323
Brau SA (1994) Video endoscopic surgery in the community hospital. Surg Laparosc Endosc 4:222–224
Ciardo L, Agresta F, Michelet I, Bedin N (2003) Minilaparoscopic appendectomy: which indications? Chir Ital 55:699–705
D’Annibale A, Morpugno E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C (2006) Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution. Tech Coloproctol 10:303–307
Deguli M, Mineccia M, Bertone A, Arrigoni A, Pennazio M, Spandre M, Cavallero M, Calvo F (2004) Outcome of laparoscopic colorectal resection. Surg Endosc 18:427–432
Do LV, Laplante R, Miller S, Gagné JP (2005) Laparoscopic colon surgery performed safely by general surgeons in a community hospital: a review of 154 consecutive cases. Surg Endosc 19:1533–1537
Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8:171–179
Hong G, Lewis M, Tablet J, Anvari M (2002) Prospective comparison of laparoscopic versus open resection for benign colorectal disease. Surg Laparosc Endosc Percutan Tech 12:238–242
Kimura T, Wada H, Yoshida M, Kobayashi T, Kawabe A, Isogaki J, Ban S, Kazui T (1998) Laparoscopic inguinal hernia repair using fine-caliber instruments and polyester mesh. Surg Laparosc Endosc 8:300–303
Kőckerling F, Schneider C, Reymond MA, Scheidbach H, Konradt J, Bärlehner E, Bruch HP, Kuthe A, Troidl H, Hohenberger W, Laparoscopic Colorectal Surgery Study Group (1998) Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery. Surg Endosc 12:37–41
Kőckerling F, Schneider C, Reymond MA, Scheidbach H, Konradt J, Bruch HP, Zornig C, Kőhler L, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Honenberg W, Laparoscopic Colorectal Surgery Study Group (1999) Laparoscopic resection of sigmoid diverticulitis: results of a multicenter study. Surg Endosc 13:567–571
Koh DSC, Wong KS, Sim R, Ng YP, Hu ZQ, Cheong DMO, Foo A (2005) Laparoscopic-assisted colon and rectal surgery: lessons learnt from early experience. Ann Acad Med Singapore 34:223–228
Lau H, Lee F (2002) A prospective comparative study of needlescopic and conventional endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 16:1737–1740
Leggett PL, Churchmann-Winn R, Miller G (2000) Minimizing ports to improve laparoscopic cholecystectomy. Surg Endosc 14:32–36
Look M, Chew SP, Tan YC, Liew SE, Cheong DM, Tan JC, Wee SB, Teh CH, Low CH (2001) Postoperative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomized trial. J R Coll Surg Edimb 46:138–142
Manazza J, Schlachta CM, Seshadri PA, et al. (2001) Needlescopic surgery: a logical evolution from conventional laparoscopic surgery. Surg Endosc 15:1208–1212
Mar Fan MJ, Chan STF (1998) “Needlescopic” (minilaparoscopic) surgery: necessary or unnecessary? Aust N Z J Surg 68:628–629
Mulieri M (2001) La Chirurgia Minilaparoscopica. Chir Gen General Surgery XXII:197–201
Ng WT, Kong CK, Tse S, et al. (2002) Needlescopic appendectomy as a Routine procedure: “just because you can?” or “just because you cannot”? Surg Laparosc Endosc 12:301–306
Perez A, Zinner MJ, Ashley SW, Brooks DC, Whang EE (2003) What is the real value of telerobotic technology in gastrointestinal surgery? Surg Endosc 17:811–813
Reichenbach DJ, Tackett AD, Harris J, Camacho D, Graviss EA, Dewn B, Vavra A, Stiles A, Fisher WE, Brunicardi FC, Sweeney JF (2006) Laparoscopic colon resection early in the learning curve: what is the appropriate setting? Ann Surg 243:730–735
Santoro E, Agresta F, Aloisi P, Caravani A, Mancini R, Mulieri G, Ciardo LF, Bedin N, Mulieri M (2005) Is minilaparoscopic inguinal hernia repair feasible? A preliminary experience. J Laparoendosc Adv Surg Tech 15:290–293
Schadde E, Smith D, Alkoraishi AS, Begos DG (2006) Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital: a prospective analysis of 104 consecutive cases. Surg Endosc 20:1077–1082
Schlachta CM, Mamazza J, Gregoire R, Burpee SE, Poulin EC (2003) Could laparoscopic colon and rectal surgery become the standard of care? A review and experience with 750 procedures. J Can Chir 46:432–440
Schlachta CM, Mamazza J, Poulin EC (1999) Laparoscopic sigmoid resection for acute and chronic diverticulitis: an outcomes comparison with laparoscopic resection for nondiverticular disease. Surg Endosc 13:649–653
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short-term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145
Schwenk W, Neudecker J, Mall J, Bohm B, Muller JM (2000) Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs microlaparoscopic cholecystectomy. Surg Endosc 14:345–348
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Santoro, E., Agresta, F., Veltri, S. et al. Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures. Surg Endosc 22, 1248–1254 (2008). https://doi.org/10.1007/s00464-007-9601-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9601-5