Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 6/2015

01-06-2015

Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study

Authors: John H. Marks, Grace A. Montenegro, Margaret V. Shields, Joseph L. Frenkel, Gerald J. Marks

Published in: Surgical Endoscopy | Issue 6/2015

Login to get access

Abstract

Introduction

Single-port (SP) surgery has been characterized as having limited applicability regarding procedure, disease, and patient characteristics. There is a question if SP procedures offer disadvantages or advantages to multiport (MP) colorectal surgery. We hypothesize that SP is equivalent to MP and is a safe alternative in the full spectrum of colorectal disease and procedures.

Methods

A case-matched analysis of a prospectively maintained database to compare perioperative outcomes in SP versus MP was performed. Criteria included age, gender, BMI, previous abdominal surgery, previous XRT, disease process, and procedure. 95 exact matches for all 7 criteria were found between 159 SP and 1,617 MP cases. Perioperative outcomes, surgical technique, morbidity, mortality, local recurrence, and 5-year survival were analyzed.

Results

There was lower mean EBL in SP but no difference in transfusion requirement. OR time for SP left colectomy was shorter, with a trend to shorter OR times found in all procedures. 99 % SP and 98 % MP had no intra-operative complications. Conversion to open was equivalent (0/1). Mean largest incision was smaller for SP. There were no differences in return of bowel function or length of hospital stay. There were no mortalities. There were no differences in perioperative morbidity, local recurrence, distant metastasis, or overall 5-year survival.

Conclusions

SP is a safe alternative to MP colorectal surgery across the full array of procedures in equivalent patients. This study demonstrates SP has less blood loss, smaller incisions, is quicker in left colectomy, and tends to be quicker across all procedures. Conversion and morbidity rates are equivalent to MP, without compromise in quality of surgical technique. While proper training is essential, concerns regarding the inability to use SP laparoscopic colorectal surgery safely are unfounded in nearly exactly matched patients. These issues will require further study as SP laparoscopic colorectal surgery is practiced more widely.
Literature
1.
2.
Bonjer HJ et al (2007) Laparoscopically assisted vs. open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303CrossRefPubMed
3.
Delaney CP et al (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824CrossRefPubMed
4.
Kuhry E et al (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a Cochrane systematic review of randomized control trials. Cancer Treat Rev 34:498–504CrossRefPubMed
5.
Lourenco T et al (2008) Laparoscopic surgery for colorectal cancer: safe and effective? A systematic review. Surg Endosc 22:1146–1160CrossRefPubMed
6.
Huang MJ et al (2011) Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized control trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 26:415–421CrossRefPubMed
7.
Braga M et al (2011) Long-term outcomes after laparoscopic colectomy. World J Gastrointest Oncol 15:43–48
8.
Papaconstantinou HT, Thomas JS (2011) Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery 150:820–827CrossRefPubMed
9.
Huscher CG, Mingoli A, Sgarzini G et al (2011) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204:115–120CrossRefPubMed
10.
Waters JA et al (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53:1467–1472CrossRefPubMed
11.
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
12.
van der Pas MH et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218CrossRefPubMed
13.
Piskun et al (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparo-endosc Adv Surg Tech A 9:361–364CrossRef
14.
15.
Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016CrossRefPubMed
16.
17.
Ross et al (2011) Early multi-institution experience with single-incision laparoscopic colectomy. Dis Colon Rectum 54:187–192CrossRefPubMed
18.
Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs. open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186CrossRefPubMed
19.
Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic vs. open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 12:583–591CrossRefPubMed
20.
Greenblatt DY et al (2011) Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg 212(5):844–854CrossRefPubMedCentralPubMed
21.
Lee Y et al (2012) A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn’s disease: an analysis of outcomes from the NSQIP database. Colorectal Dis 14(5):572–577CrossRefPubMed
22.
Kiran RP et al (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211(2):232–238CrossRefPubMed
23.
Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024CrossRefPubMed
24.
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 53:1549–1554CrossRefPubMed
25.
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 25:1887–1892CrossRefPubMed
26.
Leroy J et al (2009) Single access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179CrossRefPubMed
27.
Cahill RA et al (2010) Single port laparoscopic total colectomy for medically uncontrolled colitis. Dis Colon Rectum 53:1143–1147CrossRefPubMed
28.
Giesler D et al (2011) Single-port laparoscopic total proctocolectomy with ileal pouch-anal anastomosis: initial operative experience. Surg Endosc 25:2175–2178CrossRef
29.
Vestweber B et al (2013) Single incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surg Endosc 27:434–442CrossRefPubMed
30.
Zhou YM et al (2012) Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci 57:2103–2112CrossRefPubMed
31.
Fujii S, Watanabe K, Ota M et al (2011) Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case–control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc 26:1403–1411CrossRefPubMed
32.
Ramos-Valadez DI, Ragupathi M, Nieto J et al (2012) Single-incision versus conventional laparoscopic sigmoid colectomy: a case matched series. Surg Endosc 26:96–102CrossRefPubMed
33.
Gaujoux S, Bretagnol F, Ferron M, Panis Y (2011) Single-incision laparoscopic colonic surgery. Colorectal Dis 13:1066–1071CrossRefPubMed
34.
Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision versus straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54:183–186CrossRefPubMed
35.
Kim SJ, Ryu GO, Choi BJ et al (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254:933–940CrossRefPubMed
36.
Lee SW, Milsom JW, Nash GM (2011) Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison. Dis Colon Rectum 54:1355–1361CrossRefPubMed
Metadata
Title
Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study
Authors
John H. Marks
Grace A. Montenegro
Margaret V. Shields
Joseph L. Frenkel
Gerald J. Marks
Publication date
01-06-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3830-1

Other articles of this Issue 6/2015

Surgical Endoscopy 6/2015 Go to the issue

OriginalPaper

Laparoscopic limited Heller myotomy without anti-reflux procedure does not induce significant long-term gastroesophageal reflux

OriginalPaper

Endoscope-assisted facelift thyroid surgery: an initial experience using a new endoscopic technique

OriginalPaper

Dual-port distal gastrectomy for the early gastric cancer

OriginalPaper

Single-incision versus multiport laparoscopic appendectomy: a case-matched comparative analysis

Review

The effect of warm-up on surgical performance: a systematic review

OriginalPaper

Effects of minimizing access trauma in laparoscopic colectomy in patients with IBD