Laparoendoscopic single-site surgery is feasible in complex colorectal resections and could enable day case colectomy

Abstract

Fast-track surgery accelerates recovery, reduces morbidity, and shortens hospital stay. However, the benefits of laparoscopic versus open surgery remain unproven within a fast-track program. Case reports of laparoendoscopic single-site (LESS) colectomies are appearing with claims of cosmetic advantage and decreased parietal trauma. This report describes the largest case series of LESS colorectal surgery and its effects on recovery. In this series, 20 consecutive unselected patients underwent LESS colorectal surgery including right hemicolectomy (n=3), extended right hemicolectomy, high anterior resection (n=2), low anterior resection involving total mesorectal excision (TME; n=3), ileocolic anastomosis (n=2, including 1 redo surgery), colectomy and ileorectal anastomosis (n=4, including 1 with ventral mesh rectopexy), panproctocolectomy (n=2), proctocolectomy and ileoanal pouch (n=2) and an abdominoperineal excision of rectum. Single-port conventional instrumentation and transversus abdominus plane (TAP) block analgesia were used. The indications included cancer (n=8), Crohn's disease (n=4), ulcerative colitis (n=3) complicated diverticulosis (n=2), and slow-transit constipation (n=3). Eight of the patients had undergone previous surgery. Most of the cases (90%) were managed successfully using the LESS technique and conventional instrumentation. Two operations (10%) were converted to standard laparoscopy, due to insufficient theater time and an unstable port. The operative time ranged from 45 to 240min (median, 110min). A normal diet was tolerated within 6h by 7 patients and in 12 to 16h (overnight) by 11 patients. Complications included anastomotic bleed (n=1), ileus (n=2), acute renal failure secondary to hyperphosphatemia and hypocalcemia (n=1), urine retention (n=1), and wound infection (n=1). The median hospital stay was 46h (range, 7-384h). Eight patients were discharged within 24h. There was one readmission (5%). Laparoendoscopic single-site colorectal resection using conventional instrumentation is feasible and safe when performed by an experienced team. The LESS approach may have advantages in terms of minimal pain, cosmesis, lower costs, and faster recovery. A randomized trial is required to confirm whether LESS offers a true patient benefit over standard laparoscopic resection.