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Comparative study of safety and outcomes of single-port access versus conventional laparoscopic colorectal surgery

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Abstract

Background

Single-port access (SPA) offers cosmetic advantages in addition to the well-recognised benefits of conventional multi-port laparoscopic (CL) surgery, and can be carried out using standard straight instruments. We report the outcomes of our early experience with SPA colorectal resections in comparison with CL surgery.

Methods

We compared the following data, patient characteristics, operating time, morbidity, operative mortality, length of hospital stay and tumour variables, of patients who underwent SPA right, left, sigmoid and total colon resections, as well as high anterior resections and panproctocolectomies, with that of patients who underwent equivalent conventional laparoscopic (CL) operations. The 40 SPA and 78 CL patients studied underwent surgery between February 2008 and September 2011.

Results

There was no difference between the SPA and CL operations, as regards the patient’s sex (55.0 vs. 62.8 % males, p = 0.411), comorbidity (ASA I 10.0 vs. 12.8 %; ASA II 57.5 vs. 59.0 %; ASA III 32.5 vs. 25.6 %; ASA IV 0 vs. 2.6 %, p = 0.722) and body mass index (26.2 vs. 28.0 kg/m2, p = 0.073). However, SPA patients were younger (mean age 54.1 vs. 64.8 years, p = 0.001), and malignancy was a less common indication for surgery (25.0 vs. 71.8 %, p < 0.001). There were no conversions to open surgery, and one death occurred in the CL group (1.3 %). Mean operating time (162 vs. 170 min, p = 0.547), median post-operative hospital stay (4 vs. 4 days, p = 0.255) and morbidity (7.5 vs. 12.8 %, p = 0.538) were comparable.

Conclusions

SPA laparoscopic surgery appears safe in the hands of experienced laparoscopic surgeons, with no increase in operating time, length of stay, morbidity and mortality. Selection of patients with indications for surgery for benign disease may be of importance to ensure an oncologically safe initial uptake of SPA colorectal practice.

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References

  1. Reynolds W (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94

    PubMed  Google Scholar 

  2. Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  3. Reza M, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928

    Article  PubMed  CAS  Google Scholar 

  4. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASSIC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  PubMed  CAS  Google Scholar 

  5. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–827

    Article  PubMed  Google Scholar 

  6. Della Flora E, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice transluminal endoscopic surgery (NOTES) for intra-abdominal surgery. Ann Surg 247:583–602

    Article  Google Scholar 

  7. Choi SI, Lee KY, Park SJ, Lee SH (2010) Single-port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer. World J Gastroenterol 16:275–278

    Article  PubMed  Google Scholar 

  8. Bucher P, Pugin F, Morel P (2008) Single-port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016

    Article  PubMed  Google Scholar 

  9. Keshava A, Mackenzie S, Al-Kubati W (2010) Single-port laparoscopic right colonic resection. Aust N Z J Surg 80:30–32

    Article  Google Scholar 

  10. Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826

    Article  PubMed  CAS  Google Scholar 

  11. Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52:1797–1801

    Article  PubMed  Google Scholar 

  12. Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive management of prior diverticulitis in a human patient. Arch Surg 144:173–179

    Article  PubMed  Google Scholar 

  13. Remzi FH, Kirat HT, Geisler DP (2010) Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol 14:253–255

    Article  PubMed  CAS  Google Scholar 

  14. Geisler DP, Condon ET, Remzi FH (2010) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12:941–943

    Article  PubMed  CAS  Google Scholar 

  15. 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 53:1143–1147

    Article  PubMed  Google Scholar 

  16. Dripps RD, Lamont A, Eckenhoff JE (1963) The role of anaesthesia in surgical mortality. JAMA 178:261–266

    Article  Google Scholar 

  17. Sobin LH, Wittekind C, International Union Against Cancer (UICC) (1997) TNM classification of malignant tumors, vol 1, 5th edn. Wiley-Liss, New York

    Google Scholar 

  18. Fuller J, Ashar BS, Carey-Corrado J (2005) Trocar-associated injuries and fatalities: an analysis of 1,399 reports to the FDA. J Minim Invasive Gynaecol 12:302–307

    Article  Google Scholar 

  19. Varadarajulu S, Tamhane A, Drelichman ER (2008) Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc 67:860–865

    Google Scholar 

  20. Li W, Xiao J (2008) Investigation for acceptance of Natural Orifice Transluminal Endoscopic Surgery by Inpatients with Digestive Diseases. Gastrointest Endosc 67:AB120

    Google Scholar 

  21. Podolsky ER, Rottman SJ, Curcillo PG 2nd (2009) Single port access (SPA) cholecystectomy: two year follow-up. JSLS 13:528–535

    Article  PubMed  Google Scholar 

  22. Chen WT, Chang SC, Chiang HC et al (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887–1892

    Article  PubMed  Google Scholar 

  23. 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 53:1549–1554

    Article  PubMed  Google Scholar 

  24. Wolthuis AM, Penninckx F, Fieuws S, D’Hoore A (2012) Outcomes for case-matched single-port colectomy comparable with conventional laparoscopic colectomy. Colorectal Dis 14:634–641

    Article  PubMed  CAS  Google Scholar 

  25. Lu CC, Lin SE, Chung KC, Rau KM (2012) Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal Dis 14:E171–E176

    Article  PubMed  Google Scholar 

  26. Keshava A, Young CJ, Mackenzie S (2010) Single-incision laparoscopic right hemicolectomy. Br J Surg 97:1881–1883

    Article  PubMed  CAS  Google Scholar 

  27. Ramos-Valadez DI, Patel CB, Ragupathi M, Pickron TB, Haas EM (2010) Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc 24:2613–2616

    Article  PubMed  Google Scholar 

  28. Chambers WM, Bicsak M, Lamparelli M, Dixon AR (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398

    Article  PubMed  CAS  Google Scholar 

  29. Geisler D, Garrett T (2011) Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases. Tech Coloproctol 15:397–401

    Article  PubMed  CAS  Google Scholar 

  30. Scala A, Huang A, Dowson HM, Rockall TA (2007) Laparoscopic colorectal surgery: results from 200 patients. Colorectal Dis 9:701–705

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University Hospital of North Tees, Hardwick, Stockton-on-Tees, TS19 8PE, UK

    V. Kanakala, D. W. Borowski, A. K. Agarwal, M. A. Tabaqchali, D. K. Garg & T. S. Gill

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  1. V. Kanakala
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  2. D. W. Borowski
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  3. A. K. Agarwal
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  4. M. A. Tabaqchali
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  5. D. K. Garg
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  6. T. S. Gill
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Correspondence to T. S. Gill.

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Kanakala, V., Borowski, D.W., Agarwal, A.K. et al. Comparative study of safety and outcomes of single-port access versus conventional laparoscopic colorectal surgery. Tech Coloproctol 16, 423–428 (2012). https://doi.org/10.1007/s10151-012-0839-0

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  • DOI: https://doi.org/10.1007/s10151-012-0839-0

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