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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