Single-Incision Versus Conventional Laparoscopic Colectomy: A Case-Matched Series

Diego I Ramos-Valadez, MD, Javier Nieto, MD, Madhu Ragupathi, MD, Chirag B Patel, PhD MSE, T. Bartley Pickron, MD, Eric M Haas, MD FACS FASCRS. Division of Minimally Invasive Elective Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas

Introduction: Single-incision laparoscopic surgery is an emerging modality that has proven to be feasible in case reports and series involving colon resection. We report the efficacy and safety of single-incision laparoscopic colectomy (SILC) through a matched-case comparison with conventional laparoscopic colectomy (CLC) for the treatment of sigmoid colon disease.

Methods: Between July 2009 and September 2010, 77 consecutive laparoscopic single incision colectomies were performed for benign and malignant diseases. A cohort of 20 patients who underwent sigmoid resection were case-matched to a cohort of patients who underwent conventional laparoscopic sigmoid colectomy based on four matching criteria. Demographic data, intraoperative parameters, and postoperative outcomes were assessed. All cases were performed with IRB approval by one of two board-certified colorectal surgeons (T.B.P. and E.M.H.). Student’s t-test was used for continuous variables and chi-square analysis was used for categorical parameters.

Results: Twenty SILC and 20 CLC cases were paired together based on four matching criteria: gender (p<1.0), age (p<0.47), pathology (p<1.0), and surgical procedure (p<1.0). Ten patients (50%) in the SILC group and eight patients (40%) in the CLC group had prior abdominal surgery (p<0.53). In the SILC group, the mean incision length was 3.3±0.8 cm. Whereas one incision was made for SILC procedures, four incisions were made for CLC procedures (one extraction site and three trocar sites). The mean operating time and intraoperative complication rate did not significantly differ between the groups. The EBL was significantly reduced in the SILC group compared to the CLC group (p<0.007). There were no conversions to open surgery and one SILC procedure (5%) required conversion to CLC (p<0.31). There were a total of 2 complications in each group (ileus x2, seroma and hematoma). The mean length of stay for the SILC and CLC groups was 3.2±1.0 and 3.8±2.1 days, respectively (p<0.25) with no readmissions or re-operative interventions. In the subset of patients with malignant disease, there was no significant difference in lymph node extraction rate (p<0.68).

Conclusion: When compared with standard laparoscopic approach, the single-incision technique did not result in longer operative times, intraoperative complication or conversion rate. This technique avoids multiple trocar sites, can be safely offered to those patients with prior abdominal surgery, and maintains a short hospital length of stay and low complication rate. Prospective series will analyze additional short-term outcomes and cost.

Table 1. Matching criteria
ProcedureGenderAge (years)PathologySIgmoid colectomy
SILC

11 male

9 female

59.0±10.017 benign
3 malignant

20

(5 splenic flexure takedown)

CLC11 male
9 female
56.4±12.617 benign
3 malignant
20 (5 splenic flexure takedown
p-valueNS, p<1.0NS, p<0.47NS, p<1.0NS, p<1.0
CLS = conventional laparoscopic colectomy; NS = not significant; SILC = single-incision laparoscopic colectomy
Table 2. Outcomes.
*significant difference
a one converted to multiport
ParameterSILCCLSp-value
Conversion to open0%a0%NS, p<1.0
EBL (mL)58.3±34.398.9±52.1*, p<0.007
Operative time (min)159.2±29.9162.1±40.3NS, p<0.80
Lymph node extraction (n=3)20.3±3.818.3±6.8NS, p<0.68
Length of stay (days)3.2±1.03.8±2.1NS, p<0.25
Complications (%)5.0%5.0%NS, p<1.0

Session: SS02
Program Number: S008

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