Single-incision Laparoscopic Colectomy Research Articles

Single-Incision Laparoscopic Anterior Resection Using a Curved Stapler.

Single-incision laparoscopic colectomy is technically limited because of such factors as instrument crowding, in-line viewing, and insufficient countertraction. In particular, it is technically difficult to cut the distal rectum from the umbilicus using an articulating linear stapler in single-incision laparoscopic anterior resection. After treating the mesorectum, the 5-mm trocar is replaced with a 12-mm trocar. The cartridge of the curved stapler is mounted while the shaft of the stapler is inserted into the 12-mm port extracorporeally. The curved stapler is inserted through the umbilical incision with the cartridge. A multichannel port is then mounted, and the abdominal cavity is reinsufflated. The curved stapler can then be operated intracorporeally. This procedure facilitates the vertical dissection of the rectum from the umbilicus. A total of 27 consecutive patients were analyzed in this study. All the procedures were safely performed without any complications. The median distance from the peritoneal reflection to the transection point of the distal bowel in single-incision laparoscopic anterior resection was 5.0 cm (range, -2.0 to 15.0). One stapler firing was required to achieve distal bowel division in 26 patients (96.3 %), whereas 2 firings were required in 1 patient (3.7 %). The median distal margin was 7.0 cm (range, 3.0-13.0). The time from the insertion of the stapler to transection was 180 seconds (range, 100-420). There were no cases of anastomotic leakage. In single-incision laparoscopic anterior resection, it is feasible to perform rectal transection from the umbilicus by using a curved stapler. This technique may allow for the omission of 1 trocar from the operation.

Randomized clinical trial of single-incision versus multiport laparoscopic colectomy

The efficacy and safety of single-incision laparoscopic colectomy (SILC) for colonic cancer remain unclear. The aim of this study was to determine the outcomes of SILC compared with multiport laparoscopic colectomy (MPLC) for colonic cancer. Patients with histologically proven colonic carcinoma located in the caecum, ascending, sigmoid or rectosigmoid colon, clinically diagnosed as stage 0-III by CT, were eligible for this study. Patients were randomized before surgery and underwent tumour dissection with complete mesocolic excision. Safety analyses were conducted according to randomization groups. A total of 200 patients were enrolled and randomized to the MPLC (100 patients) or SILC (100 patients) arm. Surgical outcomes were similar between the MPLC and SILC arms, including duration of operation (mean 162 versus 156 min respectively; P = 0·273), blood loss (mean 8·8 versus 21·4 ml; P = 0·102), conversion to open laparotomy (2·0 versus 1·0 per cent; P = 0·561), reoperation (3·0 versus 3·0 per cent; P = 1·000), time to first flatus (both median 1 day; P = 0·155) and postoperative hospital stay (both median 6; P = 0·372). The total skin incision length was significantly shorter in the SILC arm (mean 4·4 cm versus 6·8 cm in the MPLC arm; P < 0·001). The median duration of analgesia use was 5 days in the MPLC and 4 days in the SILC arm (P = 0·485). Overall complication rates were equivalent (15·0 versus 12·0 per cent respecitvely; P = 0·680). SILC is not superior to MPLC. UMIN000007220 (http://www.umin.ac.jp/ctr/index.htm).

Single-incision laparoscopic surgery for colorectal cancer.

To determine the effect of single-incision laparoscopic colectomy (SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy (CLC). A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision (SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected. No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC. SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.

Resident training in single-incision laparoscopic colectomy

Single-incision laparoscopic colectomy (SLC) is touted as an improved approach to minimally invasive surgery, although no data currently exist regarding the acquisition of this technique. The aim of this study was to evaluate resident performance and outcomes in patients undergoing SLC performed by residents vs. staff colorectal surgeons. A retrospective case-control study was conducted, including 220 patients who underwent elective surgical intervention with multiport laparoscopic colectomy (MLC, n=141) or SLC (n=79) for colon cancer over a 24-month period at Yao Municipal Hospital (Yao, Japan). Data on patient demographics, operative data, oncological outcomes and short-term outcomes were evaluated for statistical significance. To investigate issues regarding the surgical procedures, the entire operation was recorded on video for all patients and was divided into 6 procedures, with each procedure measured in seconds. Senior-level residents were able to safely perform MLC under appropriate experienced supervision. For SLC, 1 case required conversion to an open procedure. No case required additional trocar placement. The mean operative times were similar for the staff and resident groups for total colon cancer (192.5 and 217.5 min, respectively; P=0.88), whereas the operative times of the staff group for right-sided colon cancer were significantly longer, and the operative times of the resident group for left-sided colon cancer were significantly longer. In addition, the overall perioperative outcomes, including blood loss, number of harvested lymph nodes, length of the surgical margin and complications, were similar between the two groups. When video recordings were evaluated by dividing the surgical process for the right colon into 4 procedures and that for the left colon into 6 procedures, the results demonstrated that the residents required more time to close the mesenteric margin for the left colon compared with the staff performing the same procedure (3,470.1±1,258.5 vs. 5,218.6±2,341.2 sec; P=0.01). Therefore, senior-level residents were able to safely perform SLC under appropriate experienced supervision. For the left colon, the main challenge for the residents appeared to be the closure of the mesenteric margin. Our data support that it is possible to train senior residents to complete a SLC safely and with the same efficacy as staff surgeons.

Outcomes for single-incision laparoscopic colectomy surgery in obese patients: a case-matched study.

Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients. Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)) and then matched on patient characteristics, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were operative time, length of stay (LOS), and conversion, complication, and readmission rates for each cohort. A total of 160 patients were evaluated-80 in each cohort. Patients were well matched in demographics, diagnosis, and procedure variables. The obese cohort had significantly higher BMI (p < 0.001) and ASA scores (p = 0.035). Operative time (176.9 ± 64.0 vs. 144.4 ± 47.2 min, p < 0.001) and estimated blood loss (89.0 ± 139.5 vs. 51.6 ± 38.0 ml, p < 0.001) were significantly higher in the obese. There were no significant differences in conversion rates (p = 0.682), final incision length (p = 0.088), LOS (p = 0.332), postoperative complications (p = 0.430), or readmissions (p = 1.000) in the obese versus non-obese. Further, in malignant cases, lymph nodes harvested (p = 0.757) and negative distal margins (p = 1.000) were comparable across cohorts. Single-incision laparoscopic colectomy in obese patients had significantly longer operative times, but comparable conversion rates, oncologic outcomes, lengths of stay, complication, and readmission rates as the non-obese cohorts. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILS may be the ideal platform to optimize outcomes in colorectal surgery. With additional operative time, the obese can realize the same clinical and quality benefits of minimally invasive surgery as the non-obese.

Perioperative and Oncologic Outcomes of Single-incision Laparoscopy Compared with Conventional Laparoscopy for Colon Cancer: An Observational Propensity Score-matched Study

Single-incision laparoscopic (SIL) surgery is a recent advance in minimally invasive surgical techniques. From May 2011 to August 2012, 77 patients underwent primary SIL surgery for colon cancer by one colorectal surgeon. Among them, 61 patients were one-to-one-matched to control patients who had undergone conventional laparoscopic (CL) surgery with a propensity-matched score, and the outcomes were compared. Two hundred forty-seven patients with colon cancer underwent radical colectomy. Of these, 77 patients underwent SIL colectomy. After matching, there were no significant differences in the general characteristics between the patients undergoing the two types of surgery. Operation time was significantly longer in SIL surgery (139 vs 121 minutes, P = 0.001), but procedure time (107 vs 99 minutes, P = 0.069) was not significantly longer than CL surgery after eliminating closure time (31 vs 22 minutes, P < 0.001) from the operation time. There was no significant difference in postoperative complications between the two groups (3.3 vs 1.6%, P = 1.000). The mean number of harvested lymph nodes was 23 and 22 for SIL and CL surgery, respectively (P = 0.332). The mean follow-up period was 15.7 for the SIL group and 21.4 months for the CL group (P < 0.001) with two recurrences in the SIL group (3.3%) and three recurrences in the CL group (4.9%, P = 1.000). Disease-free survival at 20 months did not differ significantly between the two groups (93.3 vs 94.7%, P = 0.939). SIL for colonic malignancy can be safely applied for various types of operations and can provide equivalent oncologic resection and perioperative outcomes compared with CL surgery.

Reduced port laparoscopic surgery for rectal cancer.

See Article on Page 16-22 Due to the significant improvement in minimal invasive surgery, a large group of surgeons has focused on cosmetic results and minimization of the number and the size of the ports. In addition, a single-incision laparoscopic colectomy was recently introduced to reduce patient's trauma related with conventional multiport approaches. In a single-incision laparoscopic colectomy, all trocars are inserted through one umbilical incision. However, published studies are limited, for the most part, to the right colon [1] and the sigmoid colon [2], and single-incision laparoscopic surgery in the field of rectal surgery is very rare [3] because of the difficulties in many cases in securing the surgeon's operative field [4]. One study reported that the rectum was vertically lifted by using a suspension bar to obtain the operative field [4]. Transecting the lower rectum via an umbilical port and securing a sufficient distal margin is very challenging because of the technical limitation that the tip of the laparoscopic stapler can be bent only 45 degrees. Numerous studies of single-incision laparoscopic rectal surgery in which multiple staplers were used for making an incision have reported that the chance of anastomotic leakage was decreased when the number of linear stapler used in lower rectum transection was reduced [5, 6]. Pelvic drainage after rectal surgery is required for the early detection of anastomotic leakage and to avoid reoperation. A single incision site after the rectal incision can be used as an incision for drainage in reduced port laparoscopic rectal surgery. In this study, the authors performed reduced port laparoscopic surgery on 20 colorectal cancer patients by using an umbilical port and an additional port in the right lower quadrant. The operation time (231 minutes), blood loss (100 mL), number of staplers, days to first soft diet, length of hospital stay, number of lymph nodes harvested, circumferential resection margin involvement, complications, and the rates of local recurrence and distant metastasis were comparable to those reported in other studies. However, the authors stated that further studies were needed to confirm the benefits of the procedure [7]. A reduced port procedure allows surgeons to secure a distal resection margin and is an easier surgical procedure for treating patients with low rectal cancer than procedures using only an umbilical port. Furthermore, that the incision can be utilized for pelvic drainage for a safer operation is worth mentioning. For the validation of the advantages of such procedures, further multicenter and comparative studies are demanded.

SINGLE PORT LAPAROSCOPIC SURGERY FOR RIGHT COLON CANCER CAUSE ANALYSIS FOR CONVERSION TO LAPAROTOMY

Purpose: Analysis about disease, technical characteristics of 17 right colon cancer patients underwent conversion to laparotomy from single port laparoscopic surgery and propose related factors for indications. Methold: Consist of 17 colon cancer patients, who were conversion to laparotomy from single port laparoscopic colectomy at Hue Central Hospital from october 2010 to august 2014. Results: Mean age 61.3±14.2 years, rate male/female 11/6. Tumor invasion: T2 11.8%, T3 58.8%, T4 29.4%. Mean tumor size on CT 6.5±2.2cm. The causes of conversion: very big tumors 29.4%, invasive-adhesive tumors 47.1%, extended surgery 23.5%. Open procedures: right hemicolectomy 70.6%, right hemicolectomy plus cholecystectomy 5.9%, right hemicolectomy plus wedge-shape duodenectomy 11.8%, right hemicolectomy plus intestinal segmentectomy 5.9% and right hemicolectomy plus low-anterior rectal resection, hysterectomy 5.9%. Conclusion: Conversion to laparotomy from single port laparoscopic colectomy is necessary for very big tumors, excessive tumor adhesions and exceed the technical limitations of laparoscopic dissection. Key words: Single incision laparoscopic colectomy (SILC), single port laparoscopic colectomy (SILC), conversion to laparotomy.

Single-incision laparoscopic surgery for colon cancer in patient with situs inversus totalis: report of a case.

A preliminary experience with single-incision laparoscopic colectomy for colon cancer with situs inversus totalis (SIT) is reported. An 87-year-old man was admitted because of a fecal occult blood. A colonoscopy revealed cecal cancer. An air-barium and a computed tomography contrast enema showed the right-sided descending colon and the left-sided ascending colon and cecum. The surgical procedures were as follows: First, a Lap protector was inserted through a 2.5-cm transumbilical incision. Three 5-mm ports were placed in the Lap protector. We successfully performed ileocolectomy with lymph node dissection by using a single-incision laparoscopic approach without any technical problems. The operative time was 125min, and blood loss was negligible. Postoperative follow-up did not reveal any umbilical wound complications and recurrences.

Single-Incision Laparoscopic Sigmoidectomy

Introduction: Laparoscopic surgery has been accepted to be safe and efficacious for the management of colorectal cancer.1,2 The superiority of laparoscopy over open surgery in terms of reduced postoperative pain, shorter hospital stay, early return of bowel activity, and cosmesis has been documented as advantageous in various studies.3,4 In an attempt to reduce the potential complications such as port site bleeding, hernia, infection, and improved cosmesis, minimally invasive colorectal surgery is trending toward single-incision laparoscopic surgery. Bucher et al.5 and Remzi et al.6 described the first single-incision laparoscopic colectomy (SILC) in 2008. But SILC has disadvantages of prolonged operative time, limited applicability, and long learning curve.7 We successfully report the technique of single-incision laparoscopic sigmoidectomy (SILS) for a case of sigmoid colon cancer. Materials and Methods: A 62-year-old man was diagnosed with sigmoid colon adenocarcinoma in the routine screening colonoscopy in June 2013. On clinical examination, bilateral hernioplasty scars were present. His body mass index was 22.7 kg/cm2 and carcinoembryonic antigen (CEA) was 0.62 ng/mL. Colonoscopy showed encircling mass in the sigmoid colon (27–31 cm above anal verge). CT (abdomen+pelvis) showed sigmoid colon cancer stage cT2N0M0. PET CT showed fludeoxyglucose (FDG) avid malignant tumor in sigmoid colon. OCTOTM port (Dalim surginet), model 504V2-A and Olympus camera size–10 mm, LTF type VH with Deflectable Tip were used. Operative Technique: Patient's position was supine with legs abducted and minimally elevated. A 3-cm vertical incision was made through the umbilicus, and the OCTO port was inserted. The pressure was set at 11 mm Hg. SILS was performed from medial to lateral approach. Tumor was identified. Distal margin of 10 cm was marked with the help of black silk. Mesenteric dissection was done with monopolar cautery along the embryological fusion plane. Inferior mesenteric artery (IMA) was identified, dissected, clipped, and cut near the origin. Inferior mesenteric vein (IMV) was also identified, dissected, and severed. Lateral mobilization of sigmoid and descending colon was done to achieve adequate length. Sigmoid colon of 10 cm distal to the tumor was denuded. Laparoscopic bulldog was applied above the distal transection site, and the distal colorectum was irrigated through the anus. Distal colon was transected with Endo GIA stapler. Tumor was exteriorized through the OCTO port. Colon was transected 10 cm proximal to the tumor. Anvil of directional stapling technology end to end anastomosis ( DST EEA) stapler was fixed at the proximal cut end. Colon was reposited back into the abdominal cavity through the OCTO port. DST EEA stapler was inserted through anus. DST EEA trocar was introduced through the distal stump. Anvil was joined to the cartridge fork of the stapler. Stapler was then slowly approximated. Approximation was checked circumferentially for proper. Proximal colon was checked to avoid torsion. Stapler was fired and slowly withdrawn through the anus. End-to-end colo-colo anastomosis using double stapling technique was accomplished. Operative time was 4 hours and 40 minutes, the estimated blood loss was 100 mL, and the length of stay was 6 days. Pathological staging was pT3N0Mx. The postoperative recovery of patient was uneventful. Conclusion: In patients with small tumor, SILS is technically feasible and safe oncological procedure with short-term results similar to conventional laparoscopic colectomy (CLC). No competing financial interests exist. Runtime of video: 9 mins 6 secs

Single-incision Laparoscopic Surgery for Stage IV Colon Cancer

: The safety and efficacy of single-incision laparoscopic resections for patients with stage IV colorectal cancer have not been examined explicitly. This article describes our experience with single-incision laparoscopic procedures for patients with stage IV colorectal cancer. Seventy-seven patients who underwent single-incision laparoscopic colectomy between August 2010 and January 2012 were investigated retrospectively. Eleven patients were in clinical stage IV (ST4 group) and were compared with 66 patients in clinical stages 0 to III (control group). There were no differences in the intraoperative and the postoperative complications, the 30-day mortality rate, the number of the lymph nodes harvested, and the duration of postoperative hospital stay between the 2 groups. Our initial experiences suggested that single-incision laparoscopic colectomy is feasible for stage IV colon cancer patients. This is a good start comparing the outcomes of single-incision colectomy in stage IV patients with open and traditional laparoscopic colectomy.

Quality of life after laparoscopic colectomy for cancer.

Background and Objectives:This review focuses on health-related quality-of-life (HRQoL) assessment questionnaires and the influence of various parameters on HRQoL at distinct time points after laparoscopic colectomy for cancer.Methods:A PubMed electronic database literature search was conducted.Results:Twenty studies (7 prospective randomized, 5 nonrandomized, 2 retrospective, 1 matched, and 3 observational studies) used the following HRQoL tools: European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)–C30 (8 studies), EORTC QLQ-CR38 (6 studies), EORTC QLQ-CR29 (1 study), Short Form 36 (8 studies), Gastrointestinal Quality Life Index (2 studies), EuroQoL-5D (1 study), Symptoms Distress Scale (2 studies), Quality of Life Index (2 studies), and global quality of life (1 study). Long-term beneficial effects on patient HRQoL after laparoscopic colectomy for cancer have not been clearly shown compared with “open” resections. A physical function deterioration and emotional function improvement are observed during the first month. Most patients have recovered at 12 months. Distinct HRQoL domains may be affected in older, female, and chemotherapy-treated patients. HRQoL-related parameters of pain and cosmesis have been assessed in few of the current studies on hand-assisted and single-incision laparoscopic colectomy.Conclusion:Studies' heterogeneity in terms of assessment tools and time points remains as the main obstacle to establish robust conclusions. The addition of more patients and extension of the follow-up period will improve our knowledge on HRQoL changes after laparoscopic colectomy for cancer.

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy.

PurposeThe aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer.MethodsForty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012.ResultsIn the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes).ConclusionSILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.

Single-Incision Laparoscopic Colectomy Using Self-Made Glove Port for Benign Colon Diseases

The instrument crowding derived from commercially available access devices in single-incision laparoscopic surgery (SILS) is a challenge to overcome. This study was designed to evaluate the short-term surgical outcomes of SILS by applying a self-made device in patients with benign colon diseases. We collected and reviewed the medical records of patients who received SILC by using a self-made glove-port system from March 2007 to July 2012. All operations were performed by a single surgeon. Sixty-four patients (36 males and 28 females) were enrolled for this study. Among them, 15 patients received right-side colon resection, 31 patients received left-side colon resection, and 18 patients received total colectomy. In the analysis of medical records from these groups of patients, we found that there was no significant difference of gender, body mass index, tumor size, incision length, and blood loss among these three groups. Furthermore, no significant difference of the pain scores, average length of hospital stay, and average duration of bowel return was observed among these three groups. However, it was notable that younger age, longer duration of operation, and longer bowel resection were indeed significantly found in the patients undergoing total colectomy. On the other hand, curved instruments were used in 5 (16.1%) of 31 patients with left-side colon resection. A simple self-made glove-port device was proven as a practical method of SILS for colorectal diseases. These findings suggested that single-incision laparoscopic total colectomy provides compatible clinical outcome in the patients with benign colon diseases compared with the other two surgical procedures used in this study.

Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease

Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease

Rational Manipulation of the Standard Laparoscopic Instruments for Single-Incision Laparoscopic Right Colectomy

This report clarifies the rational manipulation of standard laparoscopic instruments for single-incision laparoscopic right colectomy (SILRC) using the SILS Port. We classified the manipulations required into 4 techniques. Vertical manipulation was required for medial-to-lateral retroperitoneal dissection. Frontal manipulation was needed for extension and establishment of a retroperitoneal plane. External crossing manipulation was used for dissection or ligation of the ileocolic or right colic vessels. Internal crossing manipulation was required for mobilization from the cecum to ascending colon. We performed SILRC for a series of 30 consecutive patients. One additional port was needed in 5 of the patients (16.7%) because of severe adhesion between the ileum and abdominal wall. No intraoperative complications were encountered. Four rational manipulations of the standard laparoscopic instruments are required for SILRC using the SILS Port. However, more experience and comparative trials are needed to determine the exact role of SILRC.

Critical appraisal of learning curve for single incision laparoscopic right colectomy

Single-incision laparoscopic colectomy (SILC) has emerged as a viable minimally invasive surgical approach with benefits and limitations yet to be fully elucidated. Although shown to be safe and feasible, characterization of the learning curve has not been addressed. Our aim was to identify a learning curve for SILC right hemicolectomy and to determine the incidence of operative failure and complication rates during this phase. Over a 2-year period, data from 54 consecutive SILC cases performed by the same surgeon were tabulated in an institutional review board-approved database. A learning curve was generated utilizing cumulative sum (CUSUM) methodology to assess changes in total operative time (OT) across the case sequence. A separate learning curve was generated utilizing risk-adjusted CUSUM analysis, taking into account patient risk factors (i.e., age, American Society of Anesthesiologists score, body mass index, prior abdominal surgeries, and tumor size for malignant cases) and operative failure (i.e., prolonged OT, conversion to open surgery, intraoperative and 30-day postoperative complications, prolonged length of stay, reoperation, readmission, and mortality). Patients had a mean age of 63.6 ± 11.5 years, mean body mass index of 27.3 ± 3.9 kg/m(2), and median American Society of Anesthesiologists score of 2. Mean OT and length of stay were 123.5 ± 28.9 min and 3.9 ± 2.4 days, respectively. There were no conversions or oncologic failures. Six patients developed 30-day postoperative complications. CUSUM analysis of OT identified achievement of the learning phase after 30 cases. When taking into account both analyses, the rate of operative failure was not statistically different between the initial 30 and the final 24 cases. In our experience, the learning curve is achieved between 30 to 36 cases. Offering this minimally invasive surgical approach does not result in increased complications or harmful results even in the early phases of the learning curve.

Single-incision laparoscopic colectomy: training the next generation

Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons. Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP). A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC. Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.

Comparison of Short-Term Surgical Outcomes after Single-Incision Laparoscopic versus Multiport Laparoscopic Right Colectomy: A Two-Center, Prospective Case-Controlled Study of 100 Patients

Background: Recent case studies have demonstrated the feasibility of single-incision laparoscopic colectomy (SILC). Few comparative studies for SILC and multiport laparoscopic colectomy (MLC) have been conducted. The aim of this case-controlled study was to compare the short-term surgical outcomes between SILC and MLC for right-sided colectomies. Methods: Between January 2010 and February 2012, data from the first 50 consecutive patients that underwent right SILS at one of the two institutions were compared with a group of 50 consecutive patients that underwent right MLC in the same period. Results: Median operative time was significantly shorter in SILC (97 vs. 112 min; p < 0.001). Between both groups, no statistically significant differences were found regarding number and nature of short-term complications, number of reoperations [4 (8%) vs. 6 (12%)], and mortality rate [1 (2%) vs. 2 (4%)]. Median postoperative hospital stay was 6 days for both groups. Conclusion: SILC is a safe and feasible procedure when performed by experienced laparoscopic surgeons. Length of hospital stay and overall complication rates are comparable with MLC. Until today, no clear advantages of SILC over MLC have been demonstrated. However, due to its smaller incisional trauma, SILC could be a major step in improving cosmetic outcomes.

Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes

Laparoscopic colectomy for malignancy currently is the standard operative technique together with open colectomy. Single-incision laparoscopic surgery (SIL) is a recent advance in minimally invasive surgical techniques. This study aimed to compare SIL right colectomy with conventional laparoscopy (CL) used to treat patients with colon cancer. This study was a retrospective analysis of data from the authors' prospectively collected colorectal surgery database. Between August 2009 and November 2010, 159 patients who underwent primary laparoscopic right colectomy at the Samsung Medical Center were recruited to participate in this study. Of these, 66 patients underwent SIL colectomy. The SIL and CL right colectomy groups did not differ significantly in terms of general characteristics including age, sex, body mass index (BMI), American society of anesthesiology (ASA) score, previous abdominal operation, and diagnosis. The two groups also did not differ significantly in terms of perioperative complications (9.1 vs. 15.1 %, p = 0.335). Oncologic resection was similar in the two groups. The mean number of harvested lymph nodes was 24 for SIL and 27 for CL right colectomy (p = 0.068). Tumor size, disease stage, adjuvant chemotherapy, and proximal and distal resection margins did not differ significantly between the two groups. The mean follow-up period was 24.5 for the SIL group and 26.4 months for the CL group (p = 0.098), with six recurrences in the SIL group (9.1 %) and three recurrences in the CL group (3.2 %) (p = 0.120). One death occurred in the CL group. Disease-free survival at 24 months did not differ significantly between the two groups (89.7 vs. 96.3 %, p = 0.120). The findings show that SIL right colectomy for colon cancer is safe and can provide resection and oncologic outcomes equal to those of conventional laparoscopic right colectomy.