Conventional vs Single Port Approaches to Laparoscopic Colectomy

Patient population
Intervention
Comparator
Outcomes studied
Patients undergoing minimally invasive colorectal resection
SILS
‘Conventional laparoscopy’
Perioperative outcomes, cost, pain, cosmetic outcomes, hernia formation, oncological outcomes

Search Strategy

PubMed was queried using Medical Subject Headings (MESH); “Colon/surgery”, “Rectum/surgery”, “laparoscopy”, and search terms; “single site”, “single incision”, “single port” in combination with the Boolean operators AND or OR. English language, adult: 19+ years and humans filters were used. Relevant articles’ references were also reviewed.

Results

Among the 23 papers reviewed from the literature, there was only one RCT comparing the outcomes between SILS and CL in colorectal surgery to our knowledge, and this study was limited by sample size. One systematic review (SR), four propensity score-matched (PSM) studies, and four case-matched (CM) studies with adequate sample sizes compared and reported the short-term, long-term and oncological outcomes between the patients underwent SILS and CL in the context of colorectal surgery. Eight retrospective cohort (RC), three case–control (CC), and two case-series (CS) were also reviewed, and the results were added to the study (Table 48.1).
Table 48.1
Study size, type, nature of disease, summary of outcomes, and quality of evidence summarized for all studies
Study
Patient
Benign/malign/mixed
Study typea
Results’
Quality of evidence
SILS > CLb
SILS = CLb
CL > SILSb
Katsuno (2015) [15]
SILS (n = 107), CL (n = 107), pts w CRC
Malign
PSM
Pain, Incision length
Op time, EBL, LOS, complication, 5-year DFS and OS, LN
 
Moderate
Lee (2011) [16]
SILS (n = 46), CL (n = 46)
Mixed
CM
Cosmesis
Op time, LOS, incision length, body image score, complication
 
Moderate
Markar (2014) [17]
SILS (n = 1312), CL (n = 1862)
Mixed
SR
EBL, LOS
Op time, Complication, mortality, Hernia, LN
 
Moderate
Poon (2012) [18]
SILS (n = 25), CL (n = 25)
Mixed
RCT
LOS, pain
Op time, EBL, complications, LN, narcotic
 
Moderate
Takemasa (2014) [19]
SILS (n = 150), CL (n = 150)
Malign
PSM
Pain
Op time, EBL, LN, hernia, mortality, LOS
 
Moderate
Champagne (2012) [20]
SILS (n = 165), CL (n = 165)
Mixed
CC
EBL, pain
Op time, LOS, complication
 
Low
Chew (2013) [21]
SILS (n = 40), CL (n = 40)
Mixed
RC
 
Op time, Complication, LN, incision length, pain, narcotic, LOS
 
Low
D’Hondt (2014) [22]
SILS (n = 20), CL (n = 40), Sigmoidectomy for diverticulitis
Benign
CM
Pain, cosmesis
EBL, LOS, hernia
Op time, cost
Low
Keshava (2013) [23]
SILS (n = 75), CL (n = 74), pts underwent R hemi-colectomy
Mixed
RC
LOS, incision length
Complication
 
Low
Kim (2011) [24]
SILS (n = 73), CL (n = 106)
Malign
RC
Narcotic, LOS
Complication, LN,
Op time
Low
Kim (2015) [25]
SILS (n = 120), CL (n = 120), pts w sigmoid tm
Malign
PSM
Incision length, pain
Op time, EBL, LOS, complication, LN, 3-year DFS and OS
 
Low
Osborne (2013) [26]
SILS (n = 55), CL (n = 327)
Mixed
RC
Op time, LOS, LN
Complication, pain, hernia
 
Low
Papaconstantinou (2011) [27]
SILS (n = 39), HALS (n = 39), CL (n = 39), pts undergoing Right colectomy
Mixed
CM
Pain, LOS
Op time, EBL, incision length, complication,
 
Low
Rosati (2013) [28]
SILS (n = 50), CL (n = 50), pts undergoing Right colectomy
Mixed
CC
LOS
Op time, complication, LN
 
Low
Sangster (2015) [29]
SILS (n = 308), CL (n = 318)
Mixed
RC
EBL, LN, complication
Op time, LOS, hernia, mortality
 
Low
Stewart (2014) [30]
SILS (n = 111), CL (n = 149)
Mixed
RC
Op time
LOS, cost
 
Low
Sulu (2014) [31]
SILS (n = 95), CL (n = 90)
Mixed
CM
Op time
EBL, LOS, cost, complication
 
Low
Velthuis (2012) [32]
SILS (n = 50), CL (n = 50), pts undergoing Right colectomy
Mixed
CC
Op time
Complication, LOS, LN, hernia
 
Low
Waters (2012) [33]
SILS (n = 100), pts underwent Right hemi-colectomy
Mixed
CS
 
Short term outcomes, oncological outcomes
 
Low
Yun (2013) [34]
SILS (n = 66), CL (n = 99), pts underwent Right hemi-colectomy
Malign
RC
 
Op time, LOS, complication, LN
 
Low
Yun (2015) [35]
SILS (n = 61), CL (n = 61)
Malign
PSM
LOS, total op time
Net procedure time, complication, LN, DFS, OS
 
Low
Kanakala (2012) [36]
SILS (n = 40), CL (n = 78)
Mixed
RC
LN
Op time, LOS, complication
 
Very low
Vestweber (2013) [37]
SILS (n = 224)
Benign
CS
 
Short term outcomes
 
Very low
DFS disease free survival, OS overall survival, LN number of lymph node cleared, Pain postoperative complaining frequency of pain, Narcotic postoperative narcotic use
aCC: Case-controlled study, CM: Case-matched study, CS: Case-series, RC: Retrospective cohort study, PSM: Propensity score-matched study, SR: Systemic review
b SILSCL: Variables with a better outcome in SILS group, SILS = CL: Comparable outcomes, CLSILS: Variables with a better outcome in CL group

Perioperative Outcomes

Multiple case-matched and case series studies demonstrate that the perioperative outcomes after SILS colectomy appear to be at least equal to CL [15, 16, 1830, 32, 3437]. Katsuno et al. compared 107 patients who underwent SILS colectomy with 107 patients who underwent CL in a propensity score-matched study design and no differences were found in operative time, EBL, LOS or postoperative complications [15]. In the largest case-matched study to date comparing 318 CL cases with 308 SILS cases, no significant differences were found in terms of elective or emergent status, operative time, or conversion to laparotomy. This study did show a significant decrease in EBL in favor of the SILS group. This study also demonstrated a significant decrease in superficial surgical site infections, 11.3 % vs. 5.8 % in the SILS group with a similar LOS between the groups [29].

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Jul 13, 2018 | Posted by in ABDOMINAL MEDICINE | Comments Off on Conventional vs Single Port Approaches to Laparoscopic Colectomy

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