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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 11/2017

01-11-2017 | Review Article

Short-Term Outcomes of Single-Incision Versus Conventional Laparoscopic Surgery for Colorectal Diseases: Meta-Analysis of Randomized and Prospective Evidence

Authors: Hui-Juan Li, Lei Huang, Tuan-Jie Li, Jing Su, Ling-Rong Peng, Wei Liu

Published in: Journal of Gastrointestinal Surgery | Issue 11/2017

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Abstract

Background

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.

Objective

The aim of this study was to compare the short-term efficacy and safety of SILS with CLS for CRDs.

Methods

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.

Results

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.

Conclusions

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.
Appendix
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Literature
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.
2.
Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. The New England journal of medicine. 2004; 350:2050–9.CrossRef
3.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005; 365:1718–26.CrossRefPubMed
4.
Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. International journal of colorectal disease. 2008; 23:1013–6.CrossRefPubMed
5.
Remzi FH, Kirat HT, Kaouk JH, Geisler DP. Single-port laparoscopy in colorectal surgery. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2008; 10:823–6.CrossRef
6.
Waters JA, Rapp BM, Guzman MJ, Jester AL, Selzer DJ, Robb BW, et al. Single-port laparoscopic right hemicolectomy: the first 100 resections. Diseases of the colon and rectum. 2012; 55:134–9.CrossRefPubMed
7.
Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, et al. Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surgical endoscopy. 2012; 26:96–102.CrossRefPubMed
8.
Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP. Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Diseases of the colon and rectum. 2011; 54:183–6.CrossRefPubMed
9.
Vestweber B, Galetin T, Lammerting K, Paul C, Giehl J, Straub E, et al. Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surgical endoscopy. 2013; 27:434–42.CrossRefPubMed
10.
Marcello PW. Single incision laparoscopic colectomy: boutique surgery or the new standard? Diseases of the colon and rectum. 2011; 54:660–1.CrossRefPubMed
11.
Lv C, Wu S, Wu Y, Shi J, Su Y, Fan Y, et al. Single-incision laparoscopic versus traditional multiport laparoscopic colorectal surgery--a cumulative meta-analysis and systematic review. International journal of colorectal disease. 2013; 28:611–21.CrossRefPubMed
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.CrossRef
13.
Fung AK, Aly EH. Systematic review of single-incision laparoscopic colonic surgery. The British journal of surgery. 2012; 99:1353–64.CrossRefPubMed
14.
Bulut O, Aslak KK, Levic K, Nielsen CB, Romer E, Sorensen S, et al. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery. Techniques in coloproctology. 2015; 19:11–22.CrossRefPubMed
15.
Poon JT, Cheung CW, Fan JK, Lo OS, Law WL. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surgical endoscopy. 2012; 26:2729–34.CrossRefPubMed
16.
Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G, et al. Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. American journal of surgery. 2012; 204:115–20.CrossRefPubMed
17.
Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, et al. Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surgical endoscopy. 2011; 25:1887–92.CrossRefPubMed
18.
Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, et al. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Annals of surgery. 2011; 254:933–40.CrossRefPubMed
19.
Lee SW, Milsom JW, Nash GM. Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison. Diseases of the colon and rectum. 2011; 54:1355–61.CrossRefPubMed
20.
Lai CW, Edwards TJ, Clements DM, Coleman MG. Single port laparoscopic right colonic resection using a 'vessel-first' approach. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012; 14:1138–44.CrossRef
21.
Wolthuis AM, Penninckx F, Fieuws S, D'Hoore A. Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012;14:634–41.CrossRef
22.
Khayat A, Maggiori L, Vicaut E, Ferron M, Panis Y. Does single port improve results of laparoscopic colorectal surgery? A propensity score adjustment analysis. Surgical endoscopy. 2015;29:3216–23.CrossRefPubMed
23.
Emshoff R, Bertram S, Emshoff I. Clinically important difference thresholds of the visual analog scale: a conceptual model for identifying meaningful intraindividual changes for pain intensity. Pain. 2011;152:2277–82.CrossRefPubMed
24.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology. 2014;14:135.CrossRefPubMedPubMedCentral
25.
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC medical research methodology. 2005;5:13.CrossRefPubMedPubMedCentral
26.
Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609–13.CrossRefPubMed
27.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25:603–5.CrossRefPubMed
28.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bmj. 2009; 339:b2535.CrossRefPubMedPubMedCentral
29.
Detry MA, Lewis RJ. The intention-to-treat principle: how to assess the true effect of choosing a medical treatment. JAMA : the journal of the American Medical Association. 2014; 312:85–6.CrossRefPubMed
30.
Clarke M, Horton R. Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet. 2001; 357:1728.CrossRefPubMed
31.
Bowden J, Tierney JF, Copas AJ, Burdett S. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC medical research methodology. 2011; 11:41.CrossRefPubMedPubMedCentral
32.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in medicine. 2002; 21:1539–58.CrossRefPubMed
33.
34.
Der Simonian R, Laird N. Meta-Analysis in Clinical Trials Revisited. Contemporary clinical trials. 2015.
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.CrossRef
36.
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg. 2013; 37:259–84.CrossRefPubMed
37.
Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg. 2013; 37:285–305.CrossRefPubMed
38.
Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009; 144:961–9.CrossRefPubMed
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.CrossRef
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.CrossRefPubMed
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.CrossRef
42.
Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. International journal of colorectal disease. 2013;28:89–101.CrossRefPubMed
43.
Zhou YM, Wu LP, Zhao YF, Xu DH, Li B. Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Digestive diseases and sciences. 2012; 57:2103–12.CrossRefPubMed
44.
Hong TH, You YK, Lee KH. Transumbilical single-port laparoscopic cholecystectomy : scarless cholecystectomy. Surgical endoscopy. 2009; 23:1393–7.CrossRefPubMed
45.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. Journal of the National Cancer Institute. 2007; 99:433–41.CrossRefPubMed
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.CrossRef
47.
Papaconstantinou HT, Sharp N, Thomas JS.Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. Journal of the American College of Surgeons. 2011; 213:72–80; discussion -2.CrossRefPubMed
48.
Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, et al. Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Annals of surgery. 2012; 255:66–9.CrossRefPubMed
Metadata
Title
Short-Term Outcomes of Single-Incision Versus Conventional Laparoscopic Surgery for Colorectal Diseases: Meta-Analysis of Randomized and Prospective Evidence
Authors
Hui-Juan Li
Lei Huang
Tuan-Jie Li
Jing Su
Ling-Rong Peng
Wei Liu
Publication date
01-11-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 11/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3520-0

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