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 type^a	Results’			Quality of evidence
Study	Patient	Benign/malign/mixed	Study type^a	SILS > CL^b	SILS = CL^b	CL > SILS^b	Quality of evidence
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 SILS ≥ CL: Variables with a better outcome in SILS group, SILS = CL: Comparable outcomes, CL ≥ SILS: 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, 18–30, 32, 34–37]. 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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