Abstract
BackgroundSingle-incision laparoscopic colectomy (SILC) requires only one umbilical port site and (depending on technique) a specimen extraction site.The aim of this study was the assessment of the available evidence for the comparison of SILC to conventional multi-port laparoscopic colectomy (MLC) in adult patients, in whom elective colectomy is indicated because of malignant or benign disease. First, previous meta-analyses on this topic were assessed. Secondly, a systematic review and meta-analysis of randomised controlled trials, was performed.MethodsElectronic literature searches (CENTRAL, MEDLINE and EMBASE; up to March 2016) were performed. Additionally, we searched clinical trials registries and abstracts from surgical society meetings. For meta-analysis, risk ratios (RR) or mean differences (MD) with 95 % confidence intervals were calculated and pooled. The quality of previous meta-analyses was evaluated against established criteria (AMSTAR) and their reported results were investigated for consistency.ResultsWe identified 6 previous meta-analyses of mostly low methodological quality (AMSTAR total score: 2 − 5 out of 11 items). To fill the evidence gaps, all these meta-analyses had included non-randomised studies, but usually without assessing their risk of bias. In our systematic review and meta-analysis of randomised controlled trials exclusively, we included two randomised controlled trials with a total of 82 colorectal cancer patients. There was insufficient evidence to clarify whether SILC leads to less local complications (RR = 0.52, 95 % CI 0.14 − 1.94) or lower mortality (1 death per treatment group). Length of hospital stay was significantly shorter in the SILC group (MD = -1.20 days, 95 % CI -1.95 to -0.44). One of the two studies found postoperative pain intensity to be lower at the first day. We also identified 7 ongoing trials with a total sample size of over 1000 patients.ConclusionThe currently available study results are too sparse to detect (or rule out) relevant differences between SILC and MLC. The quality of the current evidence is low, and the additional analysis of non-randomised data attempts, but does not solve this problem. SILC should still be considered as an experimental procedure, since the evidence of well-designed randomised controlled trials is too sparse to allow any recommendation.
Highlights
IntroductionSingle-incision laparoscopic colectomy (SILC) requires only one umbilical port site and (depending on technique) a specimen extraction site
Single-incision laparoscopic colectomy (SILC) requires only one umbilical port site and a specimen extraction site
The methodological quality of these metaanalyses was assessed by using AMSTAR (‘A Measurement Tool to Assess Systematic Reviews’), which contains 11 single items and give a maximum score of 11 points [17]
Summary
Single-incision laparoscopic colectomy (SILC) requires only one umbilical port site and (depending on technique) a specimen extraction site. The aim of this study was the assessment of the available evidence for the comparison of SILC to conventional multi-port laparoscopic colectomy (MLC) in adult patients, in whom elective colectomy is indicated because of malignant or benign disease. During conventional multi-port laparoscopic colonic resection (MLC), the camera and surgical instruments are inserted through 4 − 5 trocars. Newer approaches and advances of the minimal invasive surgery aim to minimise the total length of incisions even further, which in turn may reduce the morbidity of the abdominal wall, such as wound pain, wound infection and hernia formation. This implies the expectation of a faster recovery in the early postoperative phase. The likely limitations of SILC include an additional learning curve and advanced laparoscopic skill requirements [7], because triangulation is missing, when all instruments are oriented intraabdominally in the same direction [8, 9]
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