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Single-Incision Versus Hand-Assisted Laparoscopic Colectomy: A Case-Matched Series

  • 2010 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Single-incision laparoscopic colorectal surgery is an emerging modality. We incorporated this technique as an alternative to hand-assisted laparoscopic surgery. We investigated intraoperative and short-term outcomes following single-incision laparoscopic colectomy compared with hand-assisted laparoscopic colectomy.

Methods

Between July and November 2009, single-incision colorectal procedures were performed and matched to hand-assisted procedures based on five criteria: gender, age, body mass index, pathology, and type of procedure. Demographic, intraoperative, and postoperative data were assessed.

Results

Twenty-four pairs of patients with a mean age of 55.1 years and mean body mass index of 28.5 kg/m2 were matched. The majority of cases (79.2%) were right hemicolectomies. The ranges of incision length were 2–6 cm (single incision) and 5–11 cm (hand-assisted). Mean operating time was significantly longer for single-incision procedures (143.2 min) compared with hand-assisted procedures (112.8 min), p < 0.0004. There was no significant difference in the groups regarding conversions or intraoperative complications (p < 0.083 and p < 1.0, respectively). Mean length of stay for the single-incision approach (2.7 days) was significantly shorter compared with the hand-assisted approach (3.3 days), p < 0.02.

Conclusion

Single-incision laparoscopic colectomy is a safe and feasible alternative to hand-assisted laparoscopic surgery. Although the technique required longer operative time, it resulted in smaller incision size and significantly shorter length of hospitalization.

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Abbreviations

AR:

Anterior rectosigmoidectomy

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

EBL:

Estimated blood loss

HALS:

Hand-assisted laparoscopic surgery

IL:

Incision length

LN:

Lymph node

LOS:

Length of hospital stay

OT:

Total operative time

RH:

Right hemicolectomy

SILC:

Single-incision laparoscopic colectomy

TC:

Total colectomy

References

  1. Pelosi MA, Pelosi MA, 3rd: Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy). J Reprod Med 1992;37:777–784.

    CAS  PubMed  Google Scholar 

  2. Bresadola F, Pasqualucci A, Donini A, Chiarandini P, Anania G, Terrosu G, Sistu MA, Pasetto A: Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg 1999;165:29–34.

    Article  CAS  PubMed  Google Scholar 

  3. Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H Single incision laparoscopic sigmoid colon resections without visible scar: A novel technique. Colorectal Dis 2010;12:66–70

    Article  CAS  PubMed  Google Scholar 

  4. Bucher P, Pugin F, Morel P: Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 2008;23:1013–1016.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  6. Merchant AM, Lin E: Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 2009;52:1021–1024.

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. Chambers W, Bicsak M, Lamparelli M, Dixon A: Single-incision laparoscopic surgery (sils) in complex colorectal surgery: A technique offering potential and not just cosmesis. Colorectal Dis 2009

  9. Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM: Single-incision laparoscopic right hemicolectomy: Safety and feasibility in a series of consecutive cases. Surg Endosc 2010

  10. Bucher P, Pugin F, Morel P: Transumbilical single incision laparoscopic sigmoidectomy for benign disease. Colorectal Dis 2010;12:61–65.

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  12. Bemelman WA, Ringers J, Meijer DW, de Wit CW, Bannenberg JJ: Laparoscopic-assisted colectomy with the dexterity pneumo sleeve. Dis Colon Rectum 1996;39:S59–61.

    Article  CAS  PubMed  Google Scholar 

  13. Aalbers AG, Doeksen A, MI VANBH, Bemelman WA: Hand-assisted laparoscopic versus open approach in colorectal surgery: A systematic review. Colorectal Dis 2009;12:287-295

    Article  PubMed  Google Scholar 

  14. Cima RR, Pattana-arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH: Experience with 969 minimal access colectomies: The role of hand-assisted laparoscopy in expanding minimally invasive surgery for complex colectomies. J Am Coll Surg 2008;206:946–950; discussion 950–942.

    Google Scholar 

  15. Aalbers AG, Biere SS, van Berge Henegouwen MI, Bemelman WA: Hand-assisted or laparoscopic-assisted approach in colorectal surgery: A systematic review and meta-analysis. Surg Endosc 2008;22:1769–1780.

    Article  CAS  PubMed  Google Scholar 

  16. Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL: Hand-assisted laparoscopic vs. Laparoscopic colorectal surgery: A multicenter, prospective, randomized trial. Dis Colon Rectum 2008;51:818–826; discussion 826–818.

    Google Scholar 

  17. Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM: Single incision laparoscopic-assisted right hemicolectomy technique: Application for a mass of the ascending colon (with video). Surgical Laparoscopy Endoscopy Percutaneous Techniques 2010

  18. Remzi FH, Kirat HT, Geisler DP: Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol 2009

    Google Scholar 

  19. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059.

    Article  Google Scholar 

  20. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (mrc clasicc trial): Multicentre, randomised controlled trial. Lancet 2005;365:1718–1726.

    Article  PubMed  Google Scholar 

  21. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM: Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477–484.

    Article  PubMed  Google Scholar 

  22. Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ: Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 2006;49:197–204.

    Article  PubMed  Google Scholar 

  23. Rottoli M, Bona S, Rosati R, Elmore U, Bianchi PP, Spinelli A, Bartolucci C, Montorsi M: Laparoscopic rectal resection for cancer: Effects of conversion on short-term outcome and survival. Ann Surg Oncol 2009;16:1279–1286.

    Article  PubMed  Google Scholar 

  24. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW: Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 2004;47:1680–1685.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at HoustonColorectal Surgical Associates Ltd, LLP, 7900 Fannin Street, Suite 2700, Houston, TX, 77054, USA

    Dhruvil P. Gandhi, Madhu Ragupathi, Chirag B. Patel, Diego I. Ramos-Valadez, T. Bartley Pickron & Eric M. Haas

Authors
  1. Dhruvil P. Gandhi
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  2. Madhu Ragupathi
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  3. Chirag B. Patel
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  4. Diego I. Ramos-Valadez
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  5. T. Bartley Pickron
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  6. Eric M. Haas
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Corresponding author

Correspondence to Eric M. Haas.

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Gandhi, D.P., Ragupathi, M., Patel, C.B. et al. Single-Incision Versus Hand-Assisted Laparoscopic Colectomy: A Case-Matched Series. J Gastrointest Surg 14, 1875–1880 (2010). https://doi.org/10.1007/s11605-010-1355-z

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  • DOI: https://doi.org/10.1007/s11605-010-1355-z

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