Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison.

Abstract

BACKGROUND:

New technology for single-incision laparoscopic colectomy is now commercially available, yet advantages of this approach over multiport laparoscopic colectomy have not been demonstrated.

OBJECTIVE:

This study aimed to compare the outcomes of patients who underwent single-incision vs multiport laparoscopic colectomies.

DESIGN:

Consecutive patients who underwent single-incision laparoscopic colectomies were case matched to patients who underwent multiport laparoscopic colectomies by age, operation, surgeon, diagnosis, and body mass index. Data from a prospective database and the medical records of patients treated were reviewed.

SETTINGS:

This study took place at 2 tertiary care hospitals.

PATIENTS:

Forty-six consecutive patients with a body mass index of 24 underwent single-incision laparoscopic colectomies (24 right, 18 sigmoid, 4 low anterior resection).

MAIN OUTCOME MEASURES:

Perioperative outcomes and cosmesis and body image scores at 90 days were compared.

RESULTS:

The largest incision length was significantly shorter for the single-incision group. Two patients with single incisions were converted to hand-assisted laparoscopic surgery and 4 required placement of a 5-mm trocar. A significantly greater portion of the operation was performed by the attending surgeons in the single-incision group. For right colectomies, operative times were similar. For left colectomies, operative time (149 ± 30 vs 126 ± 21 min) was significantly longer for the single-incision group. Time to flatus and bowel movements were significantly shorter for the single-incision group, but length of stay was similar. Cosmetic score was higher for the single-incision group (P = .03).

CONCLUSIONS:

Single incision is equivalent to multiport laparoscopic colectomy with regard to safety and efficacy with smaller incision size and higher cosmetic scores. Operative times were equivalent, although a greater portion of the operation was performed by the attending surgeons in the single-incision group. Further prospective studies are warranted to evaluate the advantages of single-incision laparoscopic colectomy.

• Authors: Sang W Lee, Jeffrey W Milsom, Garrett M Nash
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 54 Issue 11 Pg. 1355-61 (Nov 2011) ISSN: 1530-0358 [Electronic] United States
• PMID: 21979178 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Body Mass Index
• Colectomy (adverse effects, methods)
• Colonic Diseases (pathology, surgery)
• Female
• Humans
• Laparoscopy (adverse effects, methods)
• Length of Stay
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult