Laparoscopic Management of Malignant and Benign Colon Disease: A Comparative Analysis of Single-Incision Laparoscopic and Hand-Assisted Laparoscopic Colectomy

John Vassaur, BA, Hannah Vassaur, MS, PAC, Nicole E Sharp, MD, Daniel Jupiter, PhD, Rob Watson, MD, John Eckford, MD, F. Paul Buckley III, MD

Division of General Surgery, Scott and White Healthcare

Purpose: A review of all single-incision laparoscopic (SILS) and hand-assisted laparoscopic (HAL) colectomies in patients with colon malignancy or benign polyp disease was performed to determine the safety and feasibility of the single-incision approach.

Methods: All cases of SILS and HAL right or left/sigmoid colectomy performed for benign or malignant colon disease were examined at a single institution between January 2009 and July 2012. Statistical evaluation included descriptive analysis of demographic data as well as multivariate analyses of operative outcomes using the covariates gender, age, Body Mass Index (BMI), surgical approach, and procedure.

Results: 59 patients who underwent SILS colectomy and 33 patients who underwent HAL colectomy were reviewed. The data set included 50% men, and the patients had a mean age of 67.27 (range 28-88) years and mean BMI of 28.53 (range 17.0-47.8); there were no significant differences in these variables between the two surgical groups. 79.66% versus 54.55% of SILS and HAL cases were right colectomies, respectively, with the remainder grouped as left/sigmoid colectomies. Mean operative times for SILS and HAL colectomy were similar at 142.31 minutes and 142.48 minutes, respectively, but a t-test for non-inferiority, with a non-inferiority margin of five minutes, was not statistically significant (p-value=0.36). Additionally, a multivariate regression for operative time did not indicate that surgical technique was a significant covariate. No significant difference in complication rate was shown between SILS and HAL colectomy (Fisher exact p value 0.52) or between right and left/sigmoid colectomies (chi-squared p-value 1). 13.56% of SILS cases and 33.33% of HAL cases were converted to open, which was a statistically significant difference (chi-squared p=0.025). After including conversions from SILS to HAL (11.86%), there was no significant difference in overall conversion rates between the two groups (chi-squared test p=0.34). SILS colectomy had a significantly statistically shorter post-operative length of hospital stay (3.71 days) when compared to HAL colectomy (4.67 days) (one-sided t-test p-value 0.018). A linear model for length of stay did not indicate that surgical approach was a significant factor but did show that SILS reduced length of stay by an average of 0.53 days.

Conclusion: SILS colectomy is a safe and viable alternative to HAL colectomy for the surgical management of colon malignancy and benign polyp disease. The single-incision approach can be performed with similar operative times, conversion rates, and complication rates and may potentially shorten post-operative hospital stay. Randomized controlled trials examining these outcomes as well as the role of single-incision laparoscopy in improving post-operative pain, cosmesis, and quality of life are required to more definitively indicate any equivalences or differences in these two laparoscopic approaches.

Session: Poster Presentation

Program Number: P113

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