Top

International Journal of Colorectal Disease

Published in:

01-06-2011 | Original Article

Single-incision laparoscopic colectomy: outcomes of an emerging minimally invasive technique

Authors: Diego I. Ramos-Valadez, Chirag B. Patel, Madhu Ragupathi, Malak B. Bokhari, T. Bartley Pickron, Eric M. Haas

Published in: International Journal of Colorectal Disease | Issue 6/2011

Abstract

Purpose

Single-incision laparoscopic colectomy (SILC) is an emerging procedure in the field of minimally invasive colon and rectal surgery. The purpose of this study was to evaluate the safety and feasibility of this procedure.

Methods

Between July 2009 and April 2010, SILC was performed for 35 patients presenting with pathology of the colon. Surgical procedures included right hemicolectomy, sigmoid resection, and total colectomy. Demographic data, intraoperative parameters, and short-term postoperative outcomes were assessed.

Results

Thirty two of the 35 patients (91.4%) underwent successful completion of SILC while 3 patients required laparoscopic modifications. The mean incision length was 3.4 cm with a range of 2–6 cm. The mean total operative time (OT) for right, left, and total colectomies was 158.8 ± 31.8 min, 127.0 ± 37.1 min, and 216.3 ± 72.6 min, respectively. Overall, the OT was not significantly different between patients with a body mass index (BMI) ≥25 kg/m² (147.9 ± 47.9 min) compared to those with a BMI <25 kg/m² (123.1 ± 40.9 min). In the subset of patients with malignant disease, the mean lymph node extraction was 23.5 ± 12.0 and all margins were negative. There were no intraoperative complications, and the overall mean length of hospital stay was 2.9 ± 1.0 days (range 2–6 days). The postoperative morbidity rate was 11.4%.

Conclusions

Single-incision laparoscopic colectomy is a safe and feasible procedure for benign and malignant diseases of the colon. This modality can be successfully applied for various colorectal procedures without conversion to open surgery, resulting in a short length of hospital stay and a minimal short-term complication rate.

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

Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364PubMedCrossRef

Ponsky LE, Cherullo EE, Sawyer M, Hartke D (2008) Single access site laparoscopic radical nephrectomy: initial clinical experience. J Endourol 22:663–666PubMedCrossRef

Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD (2008) Single port access adrenalectomy. J Endourol 22:1573–1576PubMedCrossRef

Teixeira J, McGill K, Koshy N, McGinty J, Todd G (2010) Laparoscopic single-site surgery for placement of adjustable gastric band–a series of 22 cases. Surg Obes Relat Dis 6:41–45PubMedCrossRef

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

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

Uematsu D, Akiyama G, Matsuura M, Hotta K (2010) Single-access laparoscopic colectomy with a novel multiport device in sigmoid colectomy for colon cancer. Dis Colon Rectum 53:496–501PubMedCrossRef

Remzi FH, Kirat HT, Geisler DP (2009) Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol 14(3):253–255PubMedCrossRef

10.

Chambers W, Bicsak M, Lamparelli M, Dixon A (2009) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13(4):393–398CrossRef

11.

Geisler DP, Condon ET, Remzi FH (2009) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12(9):941–943PubMedCrossRef

12.

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

13.

Podolsky ER, Curcillo PG 2nd (2010) Single port access (SPA) surgery–a 24-month experience. J Gastrointest Surg 14:759–767PubMedCrossRef

14.

Yamaguchi Y, Minami K, Kawabuchi Y, Emi M, Toge T (2005) Anterior resection of rectal cancer through a one hand-size incision with or without laparoscopy: proposal of one hand-size incision surgery (OHaSIS). J Surg Res 129:136–141PubMedCrossRef

15.

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

16.

Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2010) Single incision laparoscopic-assisted right hemicolectomy technique: application for a mass of the ascending colon (with video). Surg Laparosc Endosc Percutan Tech 20(5):e146–e149PubMedCrossRef

17.

Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H (2009) Single incision laparoscopic sigmoid colon resections without visible scar: a novel technique. Colorectal Dis 12(1):66–70CrossRef

18.

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

19.

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

20.

Rieger NA, Lam FF (2009) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24:888–890PubMedCrossRef

21.

Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82:295–298PubMedCrossRef

22.

Boni L, Dionigi G, Cassinotti E, Di Giuseppe M, Diurni M, Rausei S, Cantore F, Dionigi R (2010) Single incision laparoscopic right colectomy. Surg Endosc 24:3233–32336PubMedCrossRef

23.

Gash KJ, Goede AC, Chambers W, Greenslade GL, Dixon AR (2010) Laparoendoscopic single-site surgery is feasible in complex colorectal resections and could enable day case colectomy. Surg Endosc 25(3):835–840PubMedCrossRef

24.

Vestweber B, Alfes A, Paul C, Haaf F, Vestweber KH (2010) Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc 24:3225–3228PubMedCrossRef

25.

Wong MT, Ng KH, Ho KS, Eu KW (2010) Single-incision laparoscopic surgery for right hemicolectomy: our initial experience with 10 cases. Tech Coloproctol 14:225–228PubMedCrossRef

26.

Ishida H, Okada N, Ishibashi K, Ohsawa T, Kumamoto K, Haga N (2010) Single-incision laparoscopic-assisted surgery for colon cancer via a periumbilical approach using a surgical glove: initial experience with 9 cases. Int J Surg 9(2):150–154PubMedCrossRef

27.

Law WL, Fan JK, Poon JT (2010) Single-incision laparoscopic colectomy: early experience. Dis Colon Rectum 53:284–288PubMedCrossRef

28.

Uematsu D, Akiyama G, Magishi A, Nakamura J, Hotta K (2010) Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction. Dis Colon Rectum 53:944–948PubMedCrossRef

29.

Pietrasanta D, Romano N, Prosperi V, Lorenzetti L, Basili G, Goletti O (2010) Single-incision laparoscopic right colectomy for cancer: a single-centre preliminary experience. Updates Surg 62:111–115PubMedCrossRef

30.

The 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

31.

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

32.

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

33.

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

34.

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

35.

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

36.

Tan PY, Stephens JH, Rieger NA, Hewett PJ (2008) Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion. Surg Endosc 22:1708–1714PubMedCrossRef

37.

Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef

Title: Single-incision laparoscopic colectomy: outcomes of an emerging minimally invasive technique
Authors: Diego I. Ramos-Valadez
Chirag B. Patel
Madhu Ragupathi
Malak B. Bokhari
T. Bartley Pickron
Eric M. Haas
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2011
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1185-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-incision laparoscopic colectomy: outcomes of an emerging minimally invasive technique

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2011

Port-site recurrence after laparoscopy-assisted low anterior resection: the sign of peritoneal dissemination

Sedation, analgesia, and cardiorespiratory function in colonoscopy using midazolam combined with fentanyl or propofol

Collagen fleeces do not improve colonic anastomotic strength but increase bowel obstructions in an experimental rat model

Totally double laparoscopic colon resection with intracorporeal anastomosis and transvaginal specimens extraction

Colonic anastomotic healing in the context of altered macrophage function and endotoxemia

NOD2 exonic variations in Iranian Crohn's disease patients